Targeted adjustments to physician payments to replace temporary relativity-adjusted payments on April 1, 2026

To: All Physicians and Hospitals
Category: Physician Services
Written by: Provider Services Branch
Date issued: April 1, 2026
Bulletin Number: 260304

Physician Services Agreement (PSA) initiatives effective April 1, 2026

The Ministry of Health ('the ministry’) and the Ontario Medical Association (OMA) have been working together to implement physician compensation changes agreed to under the 2024 PSA.

On April 1, 2026, the temporary relativity-adjusted increases applicable to services rendered between April 1, 2025 and March 31, 2026 will be replaced by permanent fee code adjustments as per the financial agreement of the PSA. The permanent fee code adjustments effectively reallocate the value of the temporary relativity-adjusted payments to achieve targeted investments in priority areas.

The permanent fee code adjustments—including the additions, deletions, and revisions described in greater detail below—result from recommendations made by the Physician Payment Committee (PPC), a bilateral committee established under the PSA.

New fee schedule codes effective April 1, 2026

The following table shows new fee schedule codes coming into effect for services rendered from April 1, 2026 onward: New Fee Schedule Codes Table

Delisted fee schedule codes with end date of March 31, 2026

The following table shows delisted fee schedule codes with end dates of March 31, 2026: Delisted Fee Schedule Codes Table

Fee schedule code revisions effective April 1, 2026

The following table shows fee schedule codes with revisions coming into effect for services rendered from April 1, 2026 onward: Revised Fee Schedule Codes Table

Fee schedule code value changes effective April 1, 2026

The following table shows fee schedule code value changes coming into effect for services rendered from April 1, 2026 onward: Fee Schedule Code Value Changes Table

New Occupational Medicine billing specialty with related fee code listings

Effective April 1, 2026, a new billing specialty designation under the Ontario Health Insurance Plan (OHIP) has been created for Occupational Medicine. Please refer to OHIP INFOBulletin 260305 – New OHIP Billing Specialty – Occupational Medicine for additional information.

A new 'Consultations and Visits' section has been added to the Schedule to provide fee code listings for Occupational Medicine specialists. Occupational medicine specialists should utilize these fee codes when submitting claims for applicable Occupational Medicine services rendered on or after April 1, 2026.

Surgical unbundling

Effective April 1, 2026, pre‑operative and post‑operative care and visits have been unbundled from the surgical benefit. This change supports modern surgical practice by recognizing the clinical work associated with perioperative care and better aligns payment with service delivery.

Care and visit services 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.

Integration of the Internal Medicine Office Assessment Premium into fee schedule codes

Effective April 1, 2026, the value of the 12% Internal Medicine Office Premium will be incorporated into the tariff values of internal medicine assessment fee codes.

All applicable services provided on or after April 1, 2026, will be paid at the updated tariff rates. The premium will no longer appear on the monthly remittance advice under the Premium Payments section. No action is required by physicians.

Medical Assistance in Dying (MAID) code listings

Effective April 1, 2026, new fee schedule code listings have been added to the Schedule of Benefits to remunerate Medical Assistance in Dying (MAID) services. Please refer to fee codes A/C320 and K321 for additional information.

The terms and conditions associated with these new codes supersede the guidance outlined in the quick reference guide: OHIP Payments for Medical Assistance in Dying (MAID), developed jointly by the OMA and the ministry. Physicians should no longer submit MAID-related claims using fee codes A/C945 and K023.

Technical fee values effective April 1, 2026

  • All technical services will continue to pay at the 9.96% increased rate (now applied at the fee code level effective April 1, 2026) with the exception of technical services performed in hospital
  • Technical services performed in hospital are defined as those with a Service Location Indicator 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

Unit fee increases effective April 1, 2026

  • The Assistant Unit Fee will be increased to $12.91
  • The Anaesthesiologist Unit Fee will be increased to $15.96

Medical Claims Adjustments (MADJ)

Due to staged implementations, Medical Claims Adjustments (MADJ) will be required. Further information will be provided in advance of any implementation of a Medical Claims Adjustment.

  • Please also note that during the MADJ process, the claims processing system selects an entire claim and reprocesses it.
  • A single claim can include multiple fee schedule codes and all codes will be reprocessed.
  • There will be a number of claims reprocessed with no change in payment. These will typically appear on the Remittance Advice with explanatory code '55 - This deduction is an adjustment on an earlier account' and '57 - This payment is an adjustment on an earlier account'. These two transactions will net out to zero with no payment impact but will report on the Remittance Advice for reconciliation purposes.

Update your billing software

Please ensure that your billing software is updated to reflect the new fee schedule code values for any services rendered on or after April 1, 2026, before submitting your claims.

The updated Fee Schedule Master can be found on the Ministry of Health website. This file will be available for download by April 10, 2026.

Keywords/Tags

Physician Services Agreement; PSA; Physician Payment Committee; PPC; payments

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.