System changes have been implemented to support improvements to the Community Physiotherapy Clinic Program

To: Physiotherapy Clinics
Category: Physiotherapy Facilities
Written by: Physician Relations & Contract Oversight Branch, Claim Services Branch
Date issued: October 16, 2025
Bulletin Number: 251004

Overview

The Ministry of Health and the Ontario Physiotherapy Association have been making positive changes to improve the Community Physiotherapy Clinic program by expanding patient access and lessening administrative burden on primary care providers.

Program Changes Effective April 1, 2024

  1. A referral from a primary care provider (physician or nurse practitioner) for government-funded physiotherapy services is no longer required. A patient can 'self-refer' and contact a physiotherapy clinic directly to make an appointment and access government funded physiotherapy services.
  2. The eligibility criteria have been expanded to include individuals discharged from a hospital following an outpatient day surgery. Patients now have access to physiotherapy for the condition, illness, or injury that resulted in the surgery.
  3. Virtual care continues to be supported as per the College of Physiotherapists of Ontario guidelines.
  4. A patient can now receive multiple Episodes of Care (EOCs) to treat multiple diagnoses/conditions simultaneously or in succession.
    • If an EOC is being used to treat one major diagnostic code, each condition should be assessed and treated separately. The patient record should clearly articulate the assessment, goals, treatment, progress and discharge for each condition.
    • If multiple concurrent or consecutive EOCs are undertaken, all conditions should be assessed and treated separately. The patient record should clearly articulate the assessment, goals, treatment, progress and discharge for each condition.
    • A single EOC may include physiotherapy services to address multiple conditions/diagnoses that affect more than one part of the body if the treating physiotherapist determines that this is reasonable and therapeutically appropriate.

Claims Processing Changes

System updates have been implemented to support the program changes outlined above.

  1. Submission of Self-Referral Claims
    • Flagging a self-referred patient claim for manual review will no longer be required.
    • A referring number is still required for self-referral claims. For these claims, the referring number should be the billing number of the physiotherapy clinic that provided the service.
    • Claims submitted without a referring number, or with the billing number of a different clinic as the referring number, will be rejected with error code 'V09 - Invalid Referral Number'.

  2. New Fee Schedule Codes – Post Day Surgery 
    Effective April 1, 2025, two new Fee Schedule Codes (FSCs) have been introduced for physiotherapy services provided following outpatient day surgery:

    New FSCDescription of code
    V851AClinic visit – Congregate setting - post day surgery
    V852AClinic visit – Post day surgery

  3. New Fee Schedule Codes – Virtual Care 
    Effective April 1, 2025, seven new FSCs have been added for virtual physiotherapy services:

    New FSCDescription of code
    V853AVideo visit – Congregate setting - ambulatory service 0-19, 65+
    V854AVideo visit - Congregate setting - post acute hospitalization or post day surgery
    V855AVideo visit – Congregate setting - ODSP/OW recipient
    V856AVideo visit – Ambulatory service 0-19 yrs
    V857AVideo visit – Ambulatory service 65+ yrs
    V858AVideo visit – Post acute hospitalization or post day surgery
    V859AVideo visit – ODSP/OW recipient

  4. Concurrent EOC Claims

    Multiple physiotherapy FSCs submitted by any provider, for the same patient and service date, with different diagnostic codes, will be automatically approved by the system for services rendered on or after April 1, 2024.

    Please note that there is no longer a requirement to flag these claims for manual review or submit on separate dates of service for the discharge codes.

  5. Remittance Advice (RA) Explanatory Codes

    For services rendered prior to April 1, 2024, approved items will continue to be accompanied by explanatory code '30 - Service is not a benefit of OHIP (Ontario Health Insurance Plan)'.

    Starting on the November 2025 Remittance Advice, approved services with dates April 1, 2024 onward, will be accompanied by explanatory code '33 – Approved'.

    When multiple FSCs are submitted for the same patient and service date, with the same diagnostic code, one will be approved, and the remaining items will be accompanied by one of the following explanatory codes:

    • 35 — OHIP records show this service rendered has been claimed previously.
    • 36 — OHIP records show service has been rendered by another Practitioner, Group, Lab.
    • D7 — Not allowed in addition to other procedure.

Keywords/Tags

Community physiotherapy clinic; physiotherapy; physiotherapy facilities; clinic; program changes; transfer payment agreement; CPC; TPA; virtual physiotherapy services.

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.