Community surgical and diagnostic centres are reminded that they are able to accept requisitions from chiropractors.

To: Integrated Community Health Services Centres
Category: Community surgical and diagnostic centres
Written by: Health Insurance Branch and Health Programs and Delivery Division
Date issued: March 11, 2025
Bulletin Number: 250102

This bulletin is a re-issuance of information contained in INFOBulletin 2128, issued September 28, 2017. Updates have been made in relation to the Integrated Community Health Services Centres Act (2023).

Overview

Chiropractic requisitions for radiography services can be accepted at community surgical and diagnostic centres licenced under the Integrated Community Health Services Centres Act (ICHSCA). Licensed centres can bill the Ministry of Health the applicable facility cost prescribed in the Schedule of Facility Costs. Please see the specific radiography services designated in the list below.

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

Class of services effective 2008

Under Ontario Regulation 19/08, this class of services was added to radiography licences effective February 11, 2008. It is not necessary for affected Integrated Community Health Services Centre (ICHSC) operators to apply to add this service to their licences.

Implementation of change

The change was implemented as follows:

  • The chiropractor requisitions the x-ray services from an ICHSC that is licensed to provide radiography services. Patients no longer pay the chiropractor, or the ICHSC, nor would chiropractors pay the ICHSC for the production of the x-ray image in any acceptable format.
  • Chiropractors cannot requisition ultrasound services.
  • System changes were made within the claims system to allow chiropractor registration numbers to be identified in the referring physician field of the ICHSC claim. ICHSCs bill the ministry for the prescribed facility (technical) component of the x-ray.
  • The ICHSC produces the x-ray and provides it to the chiropractor for interpretation; a copy of the x-ray would be retained by the ICHSC as required by the regulations under the ICHSCA.
  • 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 ICHSC and would not be included in the quality assurance program mandated under the ICHSCA. However, the production of the image would be under the ICHSC quality assurance process, and the ICHSC 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.
  • The patient must be informed, prior to the ICHSC service being delivered, of any uninsured services related to the production of a radiographic image and the responsible professional who delivers and determines the cost for this service. This pertains to the interpretation of a radiographic image by a physician or a chiropractor.

Please note that facility cost claims for chiropractor requisitioned x-rays will be rejected if the chiropractor has not contacted the ministry’s web-based application for provider registration. Email the Service Support Contact Centre or call 1-800-262-6524. Hours of operation: 8:00 a.m. to 5:00 p.m. Eastern Monday to Friday, except holidays.

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 ICHSC billing number. The assigned number 991000-90 is to be used by all facilities in respect of all chiropractor referred facility cost claims submissions for x-ray services in the interpreting/reading physician field.

Example: In the billing number field AZ00 991000-90

List of specific radiography services

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

Keywords/Tags

ICHSCA; ICHSC; Integrated Community Health Services Centres; Independent Health Facilities; Community surgical and diagnostic centres; Chiropractors; Radiography

Contact information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524. Hours of operation: 8:00 a.m. to 5:00 p.m. Eastern Monday to Friday, except holidays.