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INFOBulletin

Keeping Health Care Providers informed of payment, policy or program changes

Independent Health Facilities InfoBulletins

To: Independent Health Facilities

Published by: Health Services Branch, Ministry of Health and Long-Term Care

Date Issued: September 14, 2017

Bulletin Number: 2128

Re: X-Ray Services Requisitioned by Chiropractors

Posted Electronically Only

PDF Version Portable Document Format | 1 Mb


This bulletin does not contain new information but is a re-issuance of information contained in Bulletins 2051, 2051 (amendment), 2052 and 2053 that were previously issued in 2008.

The Minister of Health and Long-Term Care designated specific radiography services (list attached) requisitioned by chiropractors and provided in an independent health facility (IHF) licensed to provide radiography as a service for or in respect of which a charge or a payment is a facility fee for the purposes of the Independent Health Facilities Act (IHFA).  The designation was published in the Ontario Gazette on February 9, 2008.  IHFs that are licensed to provide radiography services are able to accept requisitions from chiropractors, and bill the Ministry of Health and Long-Term Care in respect of the facility fee prescribed in the Schedule of Facility Fees.

Under Ontario Regulation 19/08, this new class of services was added to radiography licences effective February 11, 2008. The regulation means that it is not necessary for affected IHF operators to apply to add this service to their licences.
The change was implemented as follows:

  • The chiropractor requisitions the x-ray services from an IHF that is licensed to provide radiography services.  Patients no longer pay the chiropractor, or the IHF, nor would chiropractors pay the IHF, for the production of the x-ray imaging media.
  • System changes were made within the claims system to allow chiropractor registration numbers to be identified in the referring physician field of the IHF claim.  IHFs bill the ministry for the prescribed facility (technical) component of the x-ray.
  • The IHF produces the x-ray and provides it to the chiropractor for interpretation; a copy of the x-ray would be retained by the IHF as required by the regulations under the IHFA.
  • The x-ray is interpreted by the chiropractor; since chiropractic services are uninsured, the interpretation of the service is uninsured.
  • The chiropractor’s interpretation of the film is outside the scope of the services at the IHF and would not be included in the quality assurance program mandated under the IHFA.  However, the production of the image would be under the IHF quality assurance process, and the IHF must retain a copy of the x-ray and the requisition for the service.
  • Interpretation of the x-ray by a radiologist is not an insured service.

Please note that facility fee claims for chiropractor requisitioned x-rays will reject if the chiropractor has not contacted the ministry’s Service Support Contact Centre at sscontactcentre.MOH@ontario.ca or 1-800-262-6524 to obtain a registration number.
In order to submit billings for chiropractor referred claims for x-ray services, it is necessary to use a specific provider number in addition to the IHF billing number.  The assigned number 991000-90 is to be used by all facilities in respect of all chiropractor referred facility fee claims submissions for x-ray services in the interpreting/reading physician field.
Example:  In the billing number field AZ00 991000-90

Licensees are reminded that no charges are to be made to the chiropractor or to the patient in respect of the production of the imaging media or the performance of the services for chiropractic referred x-rays.  Such charges are illegal facility fees.

SPINE AND PELVIS

Cervical spine

X025 - two or three views
X202 - four or five views
X203 - six or more views

Thoracic spine

X027 - two views
X204 - three or more

Lumbar or lumbosacral spine

X028 - two or three views
X205 - four or five views
X206 - six or more views

Entire spine (scoliosis series)

X032 - four views
orthoroentgenogram (3 foot film)
X033 - single view
X031 - two or more views

Sacrum and/or coccyx

X034 - two views
X207 - three or more views

Sacro-iliac joints

X035 - three or more views
X208 - four or more views

Pelvis and/or hip(s)

X036 - one view
X037 - two views (e.g. AP and frog view, both hips, or AP both hips plus lateral one hip)
X038 - three or more views (e.g. pelvis and sacro-iliac joints, or AP both hips plus lateral each hip

UPPER EXTREMITIES

Clavicle

X045 - two views
X209 - three or more views

Acromioclavicular joints (bilateral) with or without weighted distraction

X046 - two views
X210 - three or more views

Sternoclavicular joints (bilateral)

X047 - two or three views
X211 - four or more views

Shoulder

X048 - two views
X212 - three or more views

Scapula

X049 - two views
X213 - three or more views

Humerus including one joint

X050 - two views
X214 - three or more views

Elbow

X051 - two views
X215 - three or four views
X216 - five or more views

Forearm including one joint

X052 - two views
X217 - three or more views

Wrist

X053 - two or three views
X218 - four or more views

Hand

X054 - two or three views
X219 - four or more views

Wrist and hand

X055 - two or three views
X220 - four or more views

Finger or thumb

X056 - two views
X221 - three or more views

LOWER EXTREMITIES

Hip (unilateral)

X060 - two or more views

Femur including one joint

X063 - two views
X223 - three or more views

Knee including patella

X065 - two views
X224 - three or four views
X225 - five or more views

Tibia and fibula including one joint

X066 - two views
X226 - three or more views

Ankle

X067 - two or three views
X227 - four or more views

Calcaneus

X068 - two views
X228 - three or more views

Foot

X069 - two or three views
X229 - four or more views

Toe

X072 - two views
X230 - three or more views

X064 - Leg length studies (orthoroentgenogram)

SKELETAL SURVEYS

Other survey studies – e.g. rheumatoid, metabolic or metastatic

X080   - single view
X081   - each additional film or review

CHEST AND ABDOMEN

Ribs

X039   - two or more views

Sternum

X040   - two or more views

If you have any questions regarding this initiative, please contact the Independent Health Facilities Program at IHFP@ontario.ca.


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