Bulletin 260506 — PSA-related fee schedule code adjustments: May updates

To: All Physicians, Hospitals, and Fertility Clinics
Category: Physician Services, Fertility Clinics
Written by: Claims Services Branch, Health Programs and Delivery Division
Date issued: May 26, 2026
Bulletin Number: 260506

Overview

Further to INFOBulletin 260304, the Ministry of Health and the Ontario Medical Association are implementing permanent adjustments to physician payments effective April 1, 2026, as part of the 2024 Physician Services Agreement (PSA).

These changes are being added to the OHIP claims system through staged implementations.

The following changes were implemented May 1, 2026 with an effective date of April 1, 2026.

Below is a list of fee schedule codes where system updates have been applied:

Claim submission

The following add-on codes are eligible for payment when billed with an approved relevant fee code by the same physician, for the same patient and for the same date of service.

If the relevant fee code is not approved on the same claim or a previous claim, the add-on code will pay at $0 with explanatory code ‘DF - Corresponding fee code was not billed or paid at zero’.

Hospital technical fee reduction

Effective April 1, 2026, all technical fees listed in the Schedule have been increased by 9.96%, except for technical services performed in hospital.

Technical services performed in a hospital are defined as those with a Service Location Indicator (SLI) of HED (Hospital Emergency Department), HOP (Hospital Out Patient), HDS (Hospital Day Surgery), HRP (Hospital Referred Patient). Note that HIP (hospital in-patient) technical fees are disallowed.

If a claim is submitted for a technical service performed in hospital with a fee billed higher than the allowable amount after the reduction is applied, the claim will be paid at the eligible amount with explanatory code ’80 - Technical Fee adjustment for hospitals’.

Medical Claims Adjustments (MADJ)

Due to staged implementations, Medical Claims Adjustments may be required for previously submitted add-on codes and technical services performed in hospital. Further information will be provided in advance of a Medical Claims Adjustment.

Please note: No action is required by the physician.

Claims requiring resubmission

E150A with Neurology Specialty (18)

E150A is eligible for payment to physicians with billing specialties of Neurosurgery (04) or Neurology (18) for claims with services dates on or after April 1, 2026. Claims submitted by physicians with any other specialty will be rejected with error code ‘A4D – Ineligible Specialty’.

Neurologists who submitted claims for eligible services rendered in the month of April 2026 that previously rejected A4D should resubmit their claims for processing.

G545A maximum services

G545A is limited to a maximum of 18 units per patient per service date, and to a maximum of 14 services per hospital admission for services rendered on or after April 1, 2026.

Eligible claims submitted in April 2026 for 18 or fewer units that rejected ‘A3H – Maximum number of services’ should be resubmitted.

B603A and S197A

Claims for fee codes B603A and S197A for services rendered in April 2026 may have rejected with error ‘V41 – Invalid fee billed’ or ‘V46 -Invalid fee approved’ due to their fee increase. Effective May 2026, these codes will no longer reject when billed at the rate effective April 1, 2026.

Previously submitted claims that rejected with V41 or V46 should be resubmitted.

Keywords/Tags

PSA 2026;Technical Fee Reduction; Hospital Technical Fees; FSM Update; E150; G545; B603; S197; A3H;V41; Neurology; 18; V46

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.