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OCA RecommendedService Codes and Fee SchedulePreamble . 2Introduction . 2Fees are Recommendations . 2How Does the OCA Establish Recommended Fees? . 3Service Code Combinations: Allowance for Multiple Interventions . 4Billing by Individual Service or by Encounter (Visit or Session) . 41000 Clinical Services. 51200 Assessments . 51300-1400 Other Services . 72000 Therapeutic Interventions . 112100 Manual Care . 112200 Physiological Modalities . 132240 Orthotics . 142300 Acupuncture . 152400 Physiological Modalities (Continued) . 162500 Rehabilitation. 182600 Other Assessments . 202900 Sessional (Per/Visit) and Time Based Fees . 233000 Specialist Services . 245000-6000 Diagnostic Radiography . 285000 General Radiographic Services . 286000 Specialty Radiographic Services . 34Sample Visit Billings . 36Appendix . 38January 20191
OCA RecommendedService Codes and Fee SchedulePREAMBLEINTRODUCTIONThe OCA Recommended Service Codes and Fee Schedule (“The Fee Schedule”) has been prepared forchiropractors, patients and payers to provide guidance regarding fair and reasonable billing forchiropractic services. The schedule is comprehensive, covering general and specialist chiropractic services.The structure and content of the schedule has changed over the years to reflect the needs of practitioners,patients and payers. Recommended fees are adjusted on a yearly basis to reflect changes in the cost ofrendering care and in the socio-economic circumstances of the day. Historically, adjustments made to theguide have aligned with general inflation.There will be no change to The Fee Schedule for 2019. The OCA will undertake a thorough review andevaluation of the entire fee schedule process. This will be a significant project that will take some time tocomplete. Aside from any adjustments for the inflation index, other influencing factors such asmarketplace trends, regional cost of living variances and the benchmarking of related organizations andfraternal partners’ fee structures will be considered, with an overall objective of simplifying the scheduleand making it more user-friendly.New for 2019 is the inclusion of WSIB and FSCO guidelines as appendices for the convenience of ourmembers.Chiropractors may not necessarily offer all the services scheduled, however, where provided, servicesshould be in accordance with the OCA’s Code of Ethics, Regulations of the College of Chiropractors ofOntario, Standards of Practice as established by the College of Chiropractors of Ontario and ClinicalPractice Guidelines.The Fee Schedule reflects services commonly provided by chiropractors, but not all services. The omissionof a specific service from The Fee Schedule does not imply that any such service cannot or should not berendered by a chiropractor or that such service is not within the scope of practice of a chiropractor. Forservices not included in The Fee Schedule, the use of the recommended hourly rate is suggested as aguideline.FEES ARE RECOMMENDATIONSThe Fee Schedule is issued for information purposes only. Adoption of the recommended fees remains atthe discretion of the practitioner. The Ontario Chiropractic Association does not set fees for chiropractors.January 20192
OCA RecommendedService Codes and Fee ScheduleRecommended fees represent the full fee for each service, inclusive of any partial or full insuranceprovisions. They are also the recommended fee for each service and should, therefore, be used bychiropractors as a guide to establish fees.The OCA recognizes that chiropractic fees may vary across the province. As with other health careprofessions, a number of factors affect the establishment of a given fee for a given service. These includethe cost to provide the service, regional and economic factors, and considerations of reasonable andcustomary practice for patient and practitioner.The fee established by a chiropractic office for a given service should be charged to all patients whoreceive that particular service, and should be charged without reference to, for example, the existence ofany third-party insurance under which the patient may be covered.According to Standards of Practice established by the College of Chiropractors of Ontario, patients mustbe informed of the cost of service before the service is performed regardless of the payer.HOW DOES THE OCA ESTABLISH RECOMMENDED FEES?Recommended fees are based on the OCA’s opinion of the value of each service. To arrive at thesevalues, consideration is given to many factors including, but not necessarily limited to: Time requirements to prepare for and deliver the service;Education and training requirements;Intensity of cognitive and physical work required to deliver the service;Level of skill required to deliver the service;Level of risk associated with delivering the service; andCosts associated with the provision of the service.Because OHIP historically mandated chiropractic billing on a “per visit” basis and not byservice/intervention, the relative value used to derive recommended fees has been, and continues to be,based on the recommended cost of a common office visit.A “common office visit” is defined as a visit consisting of spinal manipulation/adjustment.All other services (with the exception of those services provided on an hourly-rated basis) are assigned arelative value (weighting) based on this value. Relative value weighting is derived from an assessment ofthe average time required to treat an average patient by the typical practitioner in a typical practice in atypical town and the factors listed above. No changes have been made to weighting or relative values for2019.January 20193
OCA RecommendedService Codes and Fee ScheduleSERVICE CODE COMBINATIONS: ALLOWANCE FORMULTIPLE INTERVENTIONSAssessment Services are always stand-alone interventions, or the first intervention performed during apatient encounter. Therapeutic interventions may be stand-alone interventions or may be provided inconjunction with assessment services or other therapeutic intervention(s) during the same patientencounter. In this case, a reduced fee is recommended for the second or subsequent services. Orthoticand X-ray services do not have reduced fees because of the specialized nature of these services.Where The Fee Schedule provides a range (recommended minimum and recommended maximum) thefactors that should be taken into consideration in establishing the fee include: Practitioner experience and qualifications;Geography, including the impact of location on the cost of providing the service;Complexity of care (the same service may be more time consuming and costly to provide to somepatients);Specialty (chiropractors with designated specialities apply knowledge and skills based on theirspecialized training); andReporting requirements.BILLING BY INDIVIDUAL SERVICE OR BY ENCOUNTER (VISITOR SESSION)For administrative ease some chiropractors may choose to bill on a per visit basis. The Fee Schedulealso accommodates this (see Service Code 2900). Where fees are established on a per visit basis (alsocalled per session or per patient encounter), the fee should reflect the component interventions. Toensure patient understanding of the services performed, it is recommended that the components of thesession be individually recorded on the invoice even if not priced individually.January 20194
OCA RecommendedService Codes and Fee Schedule1000 CLINICAL SERVICES1200 ASSESSMENTS1200The Clinical Assessments described below comprise the case assessment and management ofpatient interactions. Chiropractors are required by the Regulated Health Professions Act (1991), theChiropractic Act (1991), the regulations under those acts, and the standards of practice, guidelines,and policies of the College of Chiropractors of Ontario to perform a diagnosis before initiatingtreatment.Varying levels of examination, evaluation, conference with or concerning patients, and theadministration of each case is included. The key determinant components of Assessment servicesinclude history, examination, review of documentation, and chiropractic decision making. Casemanagement contributory factors are counselling, coordination of care and the nature of thepresenting problem. Management services and subsequent time requirements vary with the level ofcomplexity of respective case determinant components and contributory factors.OCAServiceCodeOCA ServiceCategoriesDescription1-Jan-2019Recommended FeeMinimumMaximum1201Initial or Primary(one region)For a new or established patient, shall comprise afull history of the presenting complaint, the review ofany relevant documentation, a detailed inquiryconcerning the complaint and detailed examinationof the affected part, region or system (moreparticularly the neuromusculoskeletal system) asrequired to: (a) arrive at a diagnosis (functional orpathological); (b) complete an appropriate record offindings; (c) advise the patient on course oftreatment; (d) where appropriate, refer the patientfor other health care. The large majority of firstassessments will be "Initial or PrimaryAssessments." Time requirement is generally 20-40minutes. 88.00 150.001202Extended(more than oneregion)For a new or established patient, shall comprise aninitial assessment, but in circumstances where thisis extended to a detailed examination of more thanone region or system, or where the complaint is of acomplicated nature necessitating significantly moretime and comprehensive examination to differentiallydiagnose the condition. Time required is generally30-60 minutes. 148.00 296.00January 20195
OCA RecommendedService Codes and Fee ScheduleOCAServiceCodeOCA ServiceCategoriesDescription1-Jan-2019Recommended FeeMinimumMaximum1204Minor (includesre-assessment)For a new or established patient, shall comprise abrief history and examination of the affected part orregion, an appropriate record, and advice to thepatient. Examples: extremity trauma, such as aserious sprain where active chiropractic treatment isnot a priority; re-evaluation to monitor progress, orwhere clinical judgment results in planned treatmentinterventions not being provided. Time requirementis generally 5-15 minutes. 30.00 51.001205ComplexConsultationPerformance of comprehensive history andexamination, detailed review of existingdocumentation and/or radiographs which requires ahighly complex chiropractic opinion and results in asummary report to the referring agent. 241.00 410.001206Detailed ReportPreceded by a Complex Consultation, and wouldinclude specifics on the comprehensive history,examination, document and/or radiograph review,clinical impression, prognosis andrecommendations.Bill athourly rate1209AssessmentServices Billedat Hourly RateClinical services including assessment services maybe billed on an hourly (time based) basis. 217.00January 2019 371.006
OCA RecommendedService Codes and Fee Schedule1300-1400 OTHER SERVICESOCAServiceCodeOCA ServiceCategoryDefinitionCCI Code1-Jan-2019RecommendedFee1301Consultation (patient,third party)Opinion or advice regardingevaluation and/or management of aspecific problem is requested by apatient, another chiropractor or otherappropriate source. The requestshould be documented in the patient’srecord along with any advice andservices described and/orrecommended. This does not includethe reporting of previously performedor ordered tests, assessments, orevaluations. This may be face-to-faceor remotely delivered (telephone).Time requirement is generally per 20minutes.7.SF.12 84.001303PlanningIncludes planning for care, teamconferencing, and other patient careplanning activities. Time requirementis generally per 10-20 minutes.7.SF.12 40.001304BrokerageAssisting with insurance claims,referrals, monitoring delegated orother third party services, etc. Timerequirement is generally per 10-20minutes.7.SF.15 40.001305EducationEducation provided as the soleintervention or one of theinterventions on a patient encounterto enhance knowledge and skill thatdirectly or indirectly assists the patientto understand, monitor and managetheir situation/condition/ impairment.Includes, where applicable, provisionof educational materials such aspamphlets, tapes, books and videosbut not the cost of these materials.Time requirement is generally per 15minutes.7.SP.60 40.00January 20197
OCA RecommendedService Codes and Fee ScheduleOCAServiceCodeOCA ServiceCategoryDefinitionCCI utic communication (i.e.discussion between service providerand service recipient), provided to oron behalf of a client, to identify andevaluate, introduce and/or eliminate,reinforce and/or reduce certainattitudes on the part of the clientregarding a given situation/condition/impairment, which couldalter attitudes and in turnchange/modify behaviour. Suchcounselling sessions may be providedon a "one-to-one" or "one-to-many"basis. For example:7.SP.10.ZZ 60.00 Nutritional counsellingExercise and physical rge when chiropractor attendsthe office at the request of the patientoutside of usual office hours.N/A 64.001402Home Visit (oralternate out-of-cliniclocation) SupplementSurcharge when chiropractor travelsto the patient's home or an alternatelocation for service delivery.N/A 80.001403Missed AppointmentAppointments scheduled with theconsent of the patient and notattended without reasonable noticebeing given may result in billing thepatient equal to the value of theservice scheduled. The chiropractorshould use discretion and considerthe circumstances surrounding themissed appointment.N/ADetailed narrative report (legal,insurance, etc.) may be charged at anhourly rate. See Service Code 1420.N/ADOCUMENTATION1407Detailed NarrativeReportJanuary 2019Bill at hourly rate8
OCA RecommendedService Codes and Fee ScheduleOCAServiceCodeOCA ServiceCategoryDefinitionCCI Code1-Jan-2019RecommendedFee1408Copies of PatientRecordsThe Information and Privacy Commissioner of Ontario has established that“reasonable cost recovery” for accessing and disclosing healthinformation shall not exceed 30 for any or all of the following services: Receipt and clarification, if necessary, of a request for a record. Providing an estimate of the fee that will be payable under subsection54(10) of the Act in connection with the request. Locating and retrieving the record. Review of the contents of the record for not more than 15 minutes bythe health information custodian or an agent of the custodian todetermine if the record contains personal health information to whichaccess or disclosure may or shall be refused. Preparation of a response letter. Preparation of the record for photocopying, printing or electronictransmission. Photocopying the record to a maximum of the first 20 pages or printingthe record, if it is stored in electronic form, to a maximum of the first 20pages, excluding the printing of photographs from photographs storedin electronic form. Packaging of the photocopied or printed copy of the record for shippingor faxing. If the record is stored in electronic form, electronically transmitting acopy of the electronic record instead of printing a copy of the record andshipping or faxing the printed copy. The cost of faxing a copy of the record to a fax number in Ontario ormailing a copy of the record by ordinary mail to an address in Canada. Supervising examination of the original record for not more than 15minutes.If photocopying a record that is longer than 20 pages, practitioners maycharge 25 cents per page after the first 20 pages. Please consult the IPCOwebsite for more information on related services: 1412Form or Note: simplesick note / return towork1415Other DocumentationJanuary 2019Health Order tem/134659/index.doCertificate completion requiringminimal input and signature by thechiropractor. Examples of certificatesincluded are disability forms,institutional benefit programapplications and handicap parkingapplications.7.SJ.30 26.007.SJ.30Fees vary withcomplexity9
OCA RecommendedService Codes and Fee ScheduleOCAServiceCodeOCA ServiceCategoryDefinitionCCI Code1-Jan-2019RecommendedFeeCLINICAL PRODUCTSClinical Products andMaterialsOCAServiceCodeOCA ServiceCategory1420OtherProfessionalActivity(per hour)January 2019Clinical Products (i.e. orthotics, splints) and materials (i.e. educationalmaterial) are provided at practitioner cost plus a reasonable handlingcharge.DefinitionProfessional activity including, for examplepreparation for and testifying as a witness may becharged at an hourly rate. The hourly rate establishedby individual chiropractors will vary depending, forexample, on specialized education and training,experience, geographical location, etc. ClinicalServices may also be billed on an hourly basis. SeeService Codes 1209 and 2950.1-Jan-2019Recommended FeeMinimumMaximum 217.00 371.0010
OCA RecommendedService Codes and Fee Schedule2000 THERAPEUTIC INTERVENTIONS2000The following therapeutic interventions may be provided at the same patient encounter as anassessment service, or at a subsequent patient encounter. They may be provided as stand-aloneservices or in combination as dictated by the clinical judgement of the chiropractor. Each patientencounter includes an assessment function. In the case of a patient encounter for treatment(therapeutic intervention) this brief pre-treatment assessment to ensure that the planned treatment isstill appropriate is not billed separately but is included in the intervention. Where multiple therapeuticinterventions are provided on the same patient encounter this brief assessment need only beperformed once, so the second and subsequent therapeutic interventions are billed at a reduced rate.If the chiropractor concludes from this brief pre-treatment assessment that no therapeutic interventionis appropriate, the encounter is billed as a Minor Assessment (Service Code 1204).2100 MANUAL CAREOCAServiceCodeOCA ServiceCategoryDescription1-Jan-2019Recommended FeeAs a standalone serviceAs second orsubsequentintervention nal; one ormore regionsA specific adjustment/manipulationprocedure, directed to a spinal orintervertebral joint is a manoeuver duringwhich the joint is moved within itsanatomical range of motion using a fast,low amplitude thrust. 40.00 25.002110Adjustment/Manipulation/Mobilization, Nonspinal; one ormore jointsA specific adjustment/manipulationprocedure, directed to a non-spinal joint, isa manoeuvre during which the joint ismoved within its anatomical range ofmotion using a fast, low amplitude thrust. 34.00 19.00January 201911
OCA RecommendedService Codes and Fee ScheduleOCAServiceCodeOCA ServiceCategoryDescription1-Jan-2019Recommended FeeAs a standalone serviceAs second orsubsequentintervention Brief application of myofascial therapy insupport of manipulation and/ormobilization. Various manual therapeuticprocedures which are applied to theelastocollagenous tissues in order torestore normal flexibility and tone; mayinclude manual traction, ischemiccompression, trigger point therapy,massage, post-facilitation stretch,proprioceptive neuromuscular facilitation,post-isometric relaxation, reciprocalinhibition, and patient production ofvoluntary muscle contraction againstmanual passive resistance etc. Cannot bebilled in conjunction with 2203,Comprehensive Myofascial Therapy. Timerequirement is generally less than 10minutes.N/A 16.002203ComprehensiveMyofascialTherapy (perhour)Therapeutic procedures which are appliedto the elastocollagenous tissues in order torestore normal flexibility and tone; mayinclude manual traction, ischemiccompression, trigger point therapy,massage, post-facilitation stretch,proprioceptive neuromuscular facilitation,post-isometric relaxation, reciprocalinhibition, and patient production ofvoluntary muscle contraction againstmanual passive resistance, etc. Cannot bebilled in conjunction with 2201, SupportiveMyofascial Therapy. Bill at hourly rate;Service Code 1420.Bill at hourlyrateN/AJanuary 201912
OCA RecommendedService Codes and Fee Schedule2200 PHYSIOLOGICAL MODALITIESOCAServiceCodeOCA ServiceCategoryDescription1-Jan-2019Recommended FeeAs a standalone serviceAs second orsubsequentintervention onsamevisit/session2205UltrasoundInaudible acoustic vibrations of highfrequency that may produce either thermalor non-thermal physiological effects. 31.00 16.002206ElectricalCurrent TherapyIncludes the use of any electrical modalityfor iontophoresis, muscle stimulation,galvanic currents, Russian Faradiccurrents, combination therapy (linkage ofthe electrical current with concurrentapplication of ultrasound) and microcurrent applications where the therapistutilizes a moving electrode over thetreatment area. 31.00 16.002216HydrotherapyUse of therapeutic equipment such as aHubbard Tank (not a "hot tub") for thepurpose of mobilizing a body part or partsto facilitate movement in a gravity-reducedenvironment. Time requirement is generally15 minutes or less. 28.00 13.00January 201913
OCA RecommendedService Codes and Fee Schedule2240 ORTHOTICS2240There are currently three popular procedures — foam impression, plaster casting and electronicsensor pad — which result in the creation of in-shoe orthotics. Each of these requires twocomponents: the professional service (including assessment, fitting, and any necessary adjustment ofthe orthotic device) and the product cost.OCAServiceCodeOCA d FeeAs a standalone serviceAs second orsubsequentintervention onsamevisit/session 322.00N/AOrthoticsProfessionalServicesIncludes all professional services relatingdirectly to the provision of custom in-shoeorthotics including the assessment,casting, fitting, and follow up assessment.If following the assessment the chiropractordetermines that custom orthotics are notnecessary, the assessment will be billed asa Minor Assessment. See Service Code1204.Product CostProducts are provided at cost plus a reasonable handling charge.January 201914
OCA RecommendedService Codes and Fee Schedule2300 ACUPUNCTURE2300As provided for in the Regulated Health Professions Act and the Chiropractic Act, chiropractors whoare not members of the College of Traditional Chinese Medicine Practitioners and Acupuncturists maypractice acupuncture under their chiropractic registration with the College of Chiropractors of Ontario.The CCO has an Acupuncture Standard of Practice to which all Ontario chiropractors utilizingacupuncture must comply.OCAServiceCodeOCA ServiceCategory2310Acupuncture(includingneedle andelectroacupuncture)January 2019Description1-Jan-2019Recommended FeeThe technique of inserting thin needlesthrough the skin at specific points on thebody involving stimulation of anatomicallocations. This may incorporate a variety oftechniques including electrical stimulationof the needles.As a standalone serviceAs second orsubsequentintervention onsamevisit/session 52.00 37.0015
OCA RecommendedService Codes and Fee Schedule2400 PHYSIOLOGICAL MODALITIES (CONTINUED)OCAServiceCodeOCA ServiceCategoryDescription1-Jan-2019Recommended FeeAs a standalone serviceAs second orsubsequentintervention onsamevisit/session2401Heat or ColdTherapyThe application of heat in the form ofheating pads, heat wraps, hot baths, warmgel packs, etc., or the application of coldusing various methods including but notlimited to the use of an ice bag, a coldpack, ice massage or fluids (e.g. ethylchloride) that cool by evaporation. 26.00 11.002403TractionLong-axis mechanical distraction (static orintermittent) of a body area to providemobilization. 28.00 13.002406Paraffin BathTherapyA method of delivering heat to an affectedbody part, often joints of the hand. 28.00 13.002407Micro CurrentTherapyExposure of body part or parts to a lowfrequency wave between 300 MHZ and30,000 MHZ. 28.00 13.002409Infrared therapyExposure of body part or parts to a devicecreating an infrared spectrum whichprovides superficial heating of tissues viaradiant energy. 28.00 13.002411InterferentialCurrent TherapyElectrotherapy to body part or partsutilizing two currents of differing frequencyproducing an interference pattern in thearea treated. 28.00 13.002412TENSTranscutaneous electrical nerve stimulationby an alternating current with pulse widthsfrom 20–100 microseconds and afrequency range of 50–200 HZ. 26.00 11.002413Laser TherapyPhototherapy involving the application oflow power light. Including Low Level Laser 50.00 35.00January 201916
OCA RecommendedService Codes and Fee ScheduleOCAServiceCodeOCA ServiceCategoryDescription1-Jan-2019Recommended FeeAs a standalone serviceAs second orsubsequentintervention onsamevisit/session 100.00 85.00Therapy (LLLT) and Light Emitting DiodeTherapy (LEDT). Per 20 minutes.2415ShockwaveTherapyJanuary 2019Radial Shockwaves are high energyacoustic waves that are transmittedthrough the surface and spread radially(spherically) through the body.17
OCA RecommendedService Codes and Fee Schedule2500 REHABILITATIONOCAServiceCodeOCA ServiceCategoryDescription1-Jan-2019Recommended FeeAs a standalone serviceAs second orsubsequentintervention onsamevisit/session2501Exercise: Briefinstruction forself-directedexerciseInstruction of proper exercise technique(s)and an appropriate program to anindividual patient for one or more bodyareas for patient use in a self-directed,unsupervised manner. This may beprovided in office depending on the natureof the program and the equipmentavailable to the provider. Time requirementis generally less than 10 minutes. 28.00 13.002502Exercise/FunctionalRestoration: Inoffice constantsupervised(one-on-one)Designed for and provided to an individualpatient under constant supervision andadministered by suitably qualifiedindividuals such as the chiropractor, anoccupational therapist and/or akinesiologist in order to prevent impropertechnique and further injury. Includescomprehensive instruction for a selfdirected program. Per 20 minutes.Example, for 60 minutes bill one "standalone" and two "subsequent" fee. 68.00 53.002503Exercise/FunctionalRestoration: Inofficeintermittentsupervision orgroupFor patients performing prescribedtherapeutic exercises in the chiropractor'sfacility where supervision is intermittent, forexample when part of a group session orworking semi-independently. Per 30minutes. 56.00 41.00January 201918
OCA RecommendedService Codes and Fee ScheduleOCAServiceCodeOCA ServiceCategoryDescription1-Jan-2019Recommended FeeAs a standalone serviceAs second orsubsequentintervention trainingIncludes one-on-one proceduresdeveloping patient neuromuscular coordination through repetitive activitymovements under a variety of mechanicalconditions to pattern the motor system forparticular activities. Time requirement isgenerally less than 15 minutes. 38.00N/A2505Work/PhysicalConditioning(per hour)Program designed for an individual patienttargeting daily living activities as well asconstituent components of work-relatedactivities.Bill at hourlyrateN/A2506AquatherapySupervised exercise in the gr
The Ontario Chiropractic Association does not set fees for chiropractors. OCA Recommended Service Codes and Fee Schedule January 2019 3 Recommended fees represent the full fee for each service, inclusive of any partial or full insurance provisions. They are also the recommended fee for each service and should, therefore, be used by
