Public Notice – Amendments to the Professional Conduct Handbook Part 5 and Billing Arrangements

Public Notice: Changes to Billing Arrangements Effective February 13, 2020

On February 5, 2020, the Board of the College of Chiropractors of BC (CCBC) approved amendments to Part 5 of the Professional Conduct Handbook (PCH) which relate to Billing Arrangements.

Effective February 13, 2020, registrants must not enter into arrangements with patients for the billing or payment of fees for professional services that cover more than one patient visit. Click here to read the amendments to the PCH.

The CCBC has established Terms for Implementation which allow for billing arrangements in place as of February 13, 2020 to continue for a period of up to one year.

Amendments to Part 11 Personal and Professional Conduct of the PCH were also approved on February 5, 2020 which include the incorporation of sections from the previous version of Part 5 as well as other amendments.

What is a billing arrangement?
A billing arrangement is an agreement between a registrant and patient on how the patient will pay for fees for chiropractic services over a recommended number of office visits, including what the fees will be for those services, when those fees need to be paid, and what pre-payments there will be.  Prior to the amendment of Part 5 of the PCH, registrants were permitted to create billing arrangements that included pre-payment for up to 12 treatments.

Why did the CCBC make this change?
At least fifteen percent of complaints made to the CCBC are related to billing arrangements.  In addition, members of the public have expressed concerns to the CCBC about billing arrangements without making a complaint.  A large number of registrants have made the College aware that they are not supportive of the use of billing arrangements with patients.  At the November 2, 2019 CCBC AGM in Victoria, the registrants moved and passed a resolution that the CCBC review the use of billing arrangements.  In that review, the CCBC considered the regulations for other Canadian provinces and reviewed its internal records and Inquiry Committee file history.

The CCBC believes that any benefit there may be to patients from the use of billing arrangements is outweighed by the negatives seen in the complaints and expressions of concern from the public and registrants.  For example, the CCBC had concerns about billing arrangements being used as a tool to increase patient compliance with treatment recommendations.

The amendments to Part 5 of the PCH do not prevent registrants from advertising fees for services or offering discounted fees to a patient.  The change only eliminates billing arrangements and pre-payments.

Transition Period
The CCBC recognizes that as of February 13, 2020 registrants may already have billing arrangements in place with their patients that offend this new rule.  In certain cases, the immediate termination of an existing billing arrangement might require the patient to pay for treatment already received under that arrangement all at once, as opposed to over time in instalments. The CCBC is concerned that some patients might not be able to afford an accelerated payment of that nature.

For this reason, the Board has decided to implement the amendments to Part 5 in a manner that allows for billing arrangements in place as of February 13, 2020 to continue for a period of up to one year, provided the patients who have entered into those billing arrangements are told about the amendments to Part 5 and given the opportunity to end their billing arrangement if they wish.  Also, billing arrangements that are in place as of February 13, 2020 cannot, at any time, be extended or renewed.

Learn more about amendments to the PCH Part 5 and changes to billing arrangements:

  1. Q&A: Amendments to the PCH Part 5 – Changes to Billing Arrangements
  2. Terms for Implementation of Amendments to Part 5 of the PCH

To be clear, these terms are mandatory. The breach of any of these terms could result in investigation and disciplinary action by the CCBC.

If you have any questions or concerns, please contact me directly by email to

Michelle Da Roza


Latest News