Search every updated fee code, calculate shift revenue, estimate your FHO+ admin billing income. Built as a working reference tool for Ontario physicians.
📅 Updated March 28, 2026📄 Sources: OMA PPC Report, PSA 2024-2028, OHIP INFOBulletins, SMH ED Billing Sheet
Bill per patient seen Mon-Thu 5PM-midnight. Cannot combine with H113 (weekend) or H112 (night).
H264
ED Pelvic Exam Add-on
$12.00
Add-on to ED assessment when pelvic exam with speculum performed. Bill with H1XX base code.
A320
MAID Consultation
$174.25
Medical Assistance in Dying consultation. New code for structured MAID assessment and documentation.
C126
Medically Complex Discharge
$95.10
Replaces C121 ($40.05) for complex patients. Requires documentation of multiple comorbidities, complex med reconciliation, detailed discharge plan.
W124
LTC Day of Discharge
$71.80
New code for discharge-day work in long-term care. Covers med reconciliation, community referrals, family meetings, transition planning.
Q054
Mother & Newborn Attachment
$350 per pair
FHO+ bonus for jointly enrolling mother and newborn. Applicable at delivery or within first 28 days. Separate from Q053.
Q310
FHO+ Direct Patient Care
$80/hr (15-min units = $20)
Labs review, referral letters, Rx renewals done alongside patient care. Max 14 hrs/day. Requires time logs.
Q312
FHO+ Indirect Patient Care
$80/hr (15-min units = $20)
EMR management, case conferences, calls, paperwork, insurance forms. Max 14 hrs/day. Requires time logs.
🚨 Audit Documentation Required for Q310/Q312
Each 15-minute unit requires: (1) Start and end time, (2) Patient identifier (Q310) or task description (Q312), (3) Activity performed, (4) Outcome/follow-up. Must be contemporaneous — reconstructed logs will not withstand audit.
FHO+ Model — Complete Guide
Everything you need to know about the transition from FHO to FHO+
Compensation Changes — Before & After▼
Component
Old FHO
New FHO+
Impact
Admin billing
$0
$80/hr
+$35-60K/yr
Phone/video
$0
$68/hr
NEW
Shadow billing
19.4%
30%
+55%
Procedures
~19.4%
50%
+158%
Hospital (FFS)
~19.4%
100%
+415%
After-hours premium
30%
50%
+67%
Access Bonus
Up to 18.59%
Eliminated
→ CoC metric
Continuity of Care
N/A
75% threshold
15% penalty below
FHG premium
10%
15% (20% in 2027)
+50%
75% Continuity of Care — Rules & Penalties▼
Metric: 75% of rostered patients' primary care visits must be within your FHO group
Recovery: Achieve 75% for one quarter to restore full capitation
Exclusions: Out-of-basket services (prenatal, diabetes education, palliative, mental health K-codes)
Financial impact of penalty: On a roster of 1,400 patients, ~$25,000-35,000/year lost revenue
⚠️ The metric is calculated automatically from claims data. There's no appeals process for the measurement itself. Monitor monthly.
Q310/Q312 Billing Rules — Detailed▼
Rate: $80/hr billed in 15-minute increments ($20/unit)
Max: 14 billable hours/day (56 units)
Phone/video: 85% rate = $68/hr
Cannot bill concurrently with face-to-face visit (A001-A008) for same patient at same time
Documentation per unit: start time, end time, patient ID (Q310) or task (Q312), activity, outcome
Must be contemporaneous — cannot reconstruct time logs after the fact
Eligible Activities for Q310 (Direct):
Lab result review and patient communication
Referral letter writing
Prescription renewals with clinical review
Care coordination calls with specialists
Results communication to patients
Eligible Activities for Q312 (Indirect):
EMR management and documentation
Case conferences
Follow-up calls (non-clinical)
Insurance/disability forms
Practice administration with clinical impact
Patient Attachment Bonuses (Q053, Q054)▼
Code
Description
Old
New
Q053
Unattached patient enrolment
$350
$500(+43%)
Q054
Mother & newborn joint enrolment
—
$350NEW
At $500/patient, enrolling 20 unattached patients = $10,000. Q054 applies at delivery or within 28 days.
Expand each section for the complete fee schedule with old → new rates.
🚨 Emergency Department — Full Fee Table▼
Structural Change: Friday evening (5PM-midnight) now pays weekend rates
H13X codes now Mon-Thu only. H15X codes now include Friday evening.
👨⚕️ Family Medicine & General Practice▼
🏥 Hospital Medicine & Inpatient▼
⚡ Critical Care & Resuscitation▼
🏠 Long-Term Care▼
🌙 Special Visit Premiums & After-Hours▼
🔧 Procedures — Laceration, I&D, Skin▼
⏱️ K-Code Time-Based Services▼
🏥 FHO+ / Q-Codes / Attachment Bonuses▼
Frequently Asked Questions
When do these changes take effect?▼
All changes take effect April 1, 2026. Services rendered on or after April 1 are billed at new rates. The ED H-code structural increases (PSA Year 2) were retroactive to April 1, 2025 — those should have been reconciled already. The April 2026 changes are not retroactive.
How do I enrol in FHO+?▼
Contact your FHO group lead or LHIN/OHT coordinator. If you're already in FHO, enrolment in FHO+ is through your practice group. The transition should be administrative — no new contracts required.
What if my Continuity of Care metric is below 75%?▼
If you fall below 75% for two consecutive quarters, capitation is reduced by 15%. One quarter above 75% restores full payment. Walk-in clinic usage by your patients is the #1 driver of low CoC. Consider same-day access, extended hours, and virtual options to keep patients in-group.
Do Friday evenings really pay weekend rates now?▼
Yes. Effective April 1, 2026, Friday 5PM-midnight is reclassified as weekend for ED billing. Use H15X codes + H113 premium ($32.20), not H13X codes + H114 ($23.65). This is approximately $8-15 more per patient on Friday evenings.
Can I bill Q310/Q312 while seeing patients?▼
You cannot bill Q310/Q312 concurrently with a face-to-face visit code (A001-A008) for the same patient at the same time. You can bill admin time between patients, before/after clinic, or for a different patient than the one you're seeing face-to-face. The 15-minute units do not need to be contiguous.
What documentation do auditors expect for Q310/Q312?▼
Per unit: start time, end time, patient identifier (Q310) or task description (Q312), activity performed, outcome. Must be contemporaneous (recorded at the time of service, not reconstructed later). Most EMR systems will need a workflow update to capture this. Consider an AI-powered tool that tracks automatically.
How do I prepare my billing software?▼
Contact your EMR vendor (OSCAR, PS Suite, Accuro, etc.) and confirm they have the April 2026 fee schedule update ready. Key changes: (1) Add new codes H114, H264, C126, W124, Q054, Q310, Q312. (2) Update all fee amounts. (3) Reclassify Friday evening from H13X to H15X. (4) Configure 15-minute time tracking for Q310/Q312. Do this before April 1.
Are these changes retroactive?▼
No. The April 2026 changes apply only to services on/after April 1. Note: the ED H-code structural increases under PSA Year 2 were retroactive to April 1, 2025 — if you haven't received reconciliation for those, contact OHIP Claims Branch.
Already Updated for April 1
Aegis Clinical has every April 2026 fee code, every billing rule, and every new code built into its AI scribe. Document encounters, get billing suggestions, and catch safety issues — automatically.
Disclaimer: This tool is for informational and reference purposes only. It does not constitute billing advice, medical advice, or legal advice. The OHIP Schedule of Benefits as published by the Ontario Ministry of Health is the sole authoritative source for fee code values and billing rules. Verify all amounts against the official Schedule before billing. Aegis Clinical is not affiliated with the OMA or the Ministry of Health. While every effort has been made to ensure accuracy, fee amounts are subject to change. Always confirm with the official Schedule of Benefits.