Bulletin 260901 — 2024 PSA-related fee code adjustments: September updates

To: All Physicians, Integrated Community Health Services Centres
Category: Physician Services, Community surgical and diagnostic centres
Written by: Claims Services Branch, Health Programs and Delivery Division
Date issued: September 4, 2026
Bulletin Number: 260901

Overview

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 adjustments are being added to the OHIP claims system through staged implementations. The following changes were implemented September 1, 2026, with an effective date of April 1, 2026.

Surgical unbundling

As described in INFOBulletin 260304 titled ‘Physician Services Agreement related fee schedule code adjustments April 2026’, pre‑operative and post‑operative care and visits have been unbundled from the surgical benefit.

The following claims processing changes are effective for eligible services rendered on or after April 1, 2026:

Pre-operative assessments in hospital

In hospital, pre-operative assessments are now eligible for payment in full when provided by the physician performing the surgery within 1-2 days prior to a surgical procedure. Previously, pre-operative visits rendered by the surgeon 1 or 2 days prior to surgery were in some cases considered to be part of the surgical procedure and paid at a reduced rate with explanatory codes SB - Normal pre/post op visit(s) included in surgical fee. Visit fee previously paid - surgical fee adjusted, or S7 - Normal preoperative and postoperative care included in surgical fee.

Same-day surgery assessments

Existing rules for assessments rendered on the same date as surgery remain unchanged. Assessments provided on the day of surgery remain bundled within the surgical benefit and are not eligible for separate payment except where specific terms and conditions have been met. Please refer to the surgical preamble for additional information.

Subsequent visits on the date of surgery

Subsequent visit codes C122A, C123A, C124A, C142A, C143A, E083A, E084A are now eligible for payment, along with surgical procedure fee codes, when submitted by the same physician, for the same patient on the same date of service, subject to all other Schedule of Benefits for Physician Services requirements. Previously these claims would have been reduced or paid at $0 with explanatory codes SB - Normal pre/post op visit(s) included in surgical fee. Visit fee previously paid - surgical fee adjusted, SV - MRP visit not allowed during post operative period – fee reduced to subsequent visit fee, or S7 - Normal preoperative and postoperative care included in surgical fee.

Post-operative assessments within two weeks of surgery

In-hospital concurrent care visits and subsequent visits are eligible for payment in full within two weeks of post-operative care. Previously these claims would have been reduced or paid at $0 with explanatory codes F5 - Two weeks aftercare included in fracture fee, or S7 - Normal preoperative and postoperative care included in surgical fee.

Double balloon enteroscopy

These changes were added to the OHIP claims system on September 1, 2026, with an effective date of April 1, 2026.

Claims submission

Z588A – Double balloon enteroscopy

• Z588A is an all-inclusive fee code. With the exception of E250A, no other surgical or procedural services are eligible for payment with Z588A by the same provider, for the same patient, on the same date of service.
• If Z588A is billed with another surgical code by the same provider, for the same patient on the same date of service, only one code will pay in full and the other will pay $0 with explanatory code D7- Not allowed in addition to other procedure.

E250A – Digestive system surgical time modifier

• E250A is submitted as time-based units. Each unit is 15 minutes. The final unit should be rounded to the nearest 15 minutes. For example:
  • a 63 minute procedure should be claimed as Z588A and 4 units of E250A
  • a 68 minute procedure should be claimed as Z588A and 5 units of E250A
• E250A may only be billed when Z588A is also billed by the same provider, for the same patient, on the same date of service. E250A and Z588A must be on the same claim, or E250A may be submitted separately after Z588A has been submitted and processed.
• If E250A is submitted and no eligible claim for Z588A has been processed, E250A will be paid at $0 with explanatory code DF – Corresponding fee code not claimed or approved at $0.

Time unit calculation & other procedures performed under the same anaesthesia

• Time units are calculated based on the time spent by the physician in direct contact with the patient for the purpose of the procedure. Time commences when the physician is first in attendance with the patient in the operating/procedure room and ends when the physician is no longer in attendance with that patient in the operating/procedure room.
• When additional surgical or procedural services are performed by the same provider, for the same patient, on the same date of service, under the same anaesthesia, the total time for all surgical or procedural services should be calculated and submitted as Z588A and E250A.

Medical claims adjustment

A medical claims adjustment (MADJ) will be run at a future date to adjust all impacted claims submitted between April 1, 2026, and September 1, 2026, and ensure they are paid in accordance with the revised payment eligibility conditions. Details about the MADJ will be provided in a future INFOBulletin.

Keywords/Tags

2024 PSA; Double Balloon Enteroscopy; Z588A; E250A ;In-Hospital Concurrent Care Visit; Hospital Subsequent Visit; C122A-C123A; C142A-C143A; Pre-Operative Assessments; Post-Operative Assessments; Subsequent Visits.

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.