Permanent adjustments of the Year 1 and Year 2 increases will be effective April 1, 2023.

To: General Practitioner Focused Practice-Care of the Elderly (GPFP-COE) Physicians
Category: Primary Health Care Services, Physician Services
Written by: Negotiations Branch, Physician and Provider Services Division
Date issued: April 1, 2023

The Ministry of Health and the Ontario Medical Association have been working together to implement physician compensation increases in accordance with the 2021 Physician Services Agreement (PSA).

The PSA provides for Year 1 and Year 2 compensation increases to be implemented as permanent adjustments to physician payments effective April 1, 2023. The permanent increase amounts vary according to relativity as outlined in the PSA. They are allocated to each section or physician grouping, as per page 6 of the Financial Agreement of the PSA.

Blended Fee-For-Service (BFFS) premium increase

Effective April 1, 2023, Blended Fee-For-Service premium payments will increase from 5% to 20% of the approved amount on all shadow-billed claims.

Base payment increase

Effective April 1, 2023, the following payment elements under your funding agreement will be increased by 8.25% and will be reflected on your May 2023 Remittance Advice (RA):

  • Base Payment

Fee-For-Service threshold increase

Effective April 1, 2023, the Fee-For-Service billing limits for core services provided to non-enrolled patients will be increased by 3.3385%.

After-hours threshold increase

Effective April 1, 2023, the After-Hours Threshold will be increased by 3.3385%.

Deleted Fee Schedule codes effective April 1, 2023

Effective April 1, 2023, the following services have been delisted and removed from the basket of ‘Excluded Codes’ for the GPFP-COE model 1 patient enrolment models.

Fee CodeDescription
H400Emergency Department Sessional Fees-Sessions-Monday-Friday (other than holidays)-2000h-2400h
H401Emergency Department Sessional Fees-Sessions-Monday-Friday (other than holidays)-0000h-0400h
H402Emergency Department Sessional Fees-Sessions-Monday-Friday (other than holidays)-0400-0800h
H403Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-0000h-0400h
H404Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-0400h-0800h
H405Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-0800h-1200h
H406Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-200h-1600h
H407Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-600h-2000h
H408Emergency Department Sessional Fees-Sessions-Saturday, Sunday, Holidays-2000h-2400h

New service eligible for after-hours

Effective April 1, 2023, the new service ‘K133A-Periodic Health Visit for Adults with Intellectual and Developmental Disabilities’ is eligible for the after-hours premium when billed with a Q018A for enrolled patients.

Fee Schedule code increases effective April 1, 2023

Effective April 1, 2023, the Fee Schedule Master (FSM) will be updated to reflect new values for fee-for-service (FFS) codes as agreed to between the ministry and the OMA at the Physician Payment Committee (PPC). For more information, please see INFOBulletin 230310.

Keywords/Tags

Physician Services Agreement; PSA; physicians; payments

Contact information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524.