New FHO hourly rate payments will be available starting April 1, 2026.

To: All Family Health Organization (FHO) physicians
Category: Primary Health Care Services
Written by: Physician Relations and Contract Oversight Branch, Physician and Provider Services Division
Date issued: April 1, 2026
Bulletin Number: 260309

Overview

The Ministry of Health and the Ontario Medical Association have been working together to implement a modernized Family Health Organization (FHO) model sometimes referred to as FHO+. In accordance with the 2024 Physician Services Agreement (PSA), funding has been allocated to introduce hourly payments for direct patient care, indirect patient care, and clinical administration.

Hourly Rate Fee Codes

Effective April 1, 2026, FHO physicians will submit the following new hourly codes using the medical claims payment system (MCPS) to claim hours worked on:

  • Q310A – Direct Patient Care – In-Person or Video
    • Payable for the time spent personally providing clinical services in-person in-office, synchronous virtual care in-office and out of office, telephone-based virtual care provided in office, and clinical teaching provided concurrently with patient care to enrolled patients. For Ontario virtual care services to be insured and paid under OHIP, both the patient and the physician must be physically located in Ontario at the time the service is rendered.
  • Q311A – Direct Telephone-based Patient Care – Not in Office
    • Payable for time spent personally providing telephone-based virtual care services to enrolled patients of the FHO group when the physician is not physically present in the usual family medicine clinical practice setting
  • Q312A – Indirect Patient Care
    • Payable for time spent personally providing specific services associated with patient-specific insured services provided to enrolled patients of the FHO group where there is no direct patient contact
  • Q313A – Clinical Administration Time
    • Payable for time spent on activities not included in either Q310A, Q311A, or Q312A and are not patient-specific but require the professional expertise of a physician for management of the physician’s roster or to all enrolled patients of the FHO

Hourly rate billing rules

  • The health number, version code and birthdate fields on the claim must be left blank
  • When an hourly code is submitted without a blank health number field the claim will reject 'VHB – No HN required for HSC'
  • When an hourly code is submitted without a blank version code field the claim will reject 'VHB – No HN required for HSC'
  • When an hourly code is submitted without a blank birthdate field the claim will reject 'VH1 – Invalid Health Number'
  • The service date for any hourly‑rate billing code must reflect the actual date on which the hourly activity was performed
  • FHO signatory physicians can bill hourly codes only with their FHO group number or solo billing number
  • FHO locum physicians must bill hourly codes with their FHO group number
  • FHO income stabilization physicians are not eligible to bill hourly codes
  • When a physician other than a FHO affiliated physician submits one of the new hourly codes the claim will be rejected 'EPA – PCN Billing not approved'

Hourly rate billing limits

Hourly rate billings are limited to 56 units (14 hours) per day for any combination of hourly codes billed.

If a single claim item is billed with more than 56 units, the claim will be rejected 'A3H – Max no Services FSM'.

If an incoming hourly rate claim exceeds the combined daily limit, the item will be approved and paid at $0 with an explanatory code of 'MD – Daily Maximum has been exceeded'.

Hourly rate billings are limited to 240 hours per 28-day cycle for any combination of hourly codes billed, pro-rated based on the number of days in the billing month:

  • 28 days = 240 hours (960 units)
  • 29 days = 248.6 hours (995 units)
  • 30 days = 257.1 hours (1,029 units)
  • 31 days = 265.7 hours (1,063 units)

If an incoming hourly rate claim exceeds the combined monthly limit, the item will be approved and paid at $0 with an explanatory code of 'M5 – Monthly Maximum has been exceeded'.

No more than 25% of a physician’s total monthly hours billed can be for indirect patient care (Q312A) and clinical administrative time (Q313A).

Clinical administration time (Q313A) will be no more than five per cent (5%) of the total monthly hours billed for direct and indirect patient care (Q310A, Q311A, and Q312A).

Hourly rate payment

The new hourly codes are calculated and payable in time units of 15-minute units for each category, which will be calculated on a cumulative basis across the calendar day. The cumulative number of minutes in each category will be divided by fifteen (with any remainder of 8 minutes or more counting as a full 15-minute unit).

For example, when a physician performs 2.0 hours of direct patient care, the physician will submit a Q310A claim for 8 units of service.

The ministry shall provide the following base hourly rates per 15-minute service billed:

  • Q310A, Q312A and Q313A — $20.00 ($80.00 per hour)
  • Q311A — $17.00 ($68.00 per hour)

Relativity rates for fiscal year 2026–2027 will apply to hourly rate payments.

Additional Hourly Rate Information

Indirect Patient Care (Q312A) includes:

  • Documentation of patient interactions and charting
  • Review of results: labs, imaging, consultations, and other reports
  • Preparing referrals and requisitions
  • Chart review
  • Discussion with, and providing advice and information to the patient or the patient’s representative, via synchronous or asynchronous care communication, that is an insured service directly related to pre or post direct patient care
  • Care coordination and care planning
  • Conferencing, consulting, and meeting with other physicians and/or other health professionals for a specific patient or patients
  • Conferencing and meeting with family members and/or patient medical representatives
  • Reviewing and analyzing clinically related information/research directly related to the needs of a particular patient (example: investigating particular diagnostic and therapeutic interventions)
  • Completion of clinically required forms, reports and medical certificates of death (excluding services requested or required by a third party for other than medical requirements and for which the physician can bill the patient directly, such as insurance forms and reports, medical-legal letters and reports, insurance/industrial examinations, and physical fitness examinations for school/camp)
  • Patient-specific clinical teaching arising from Direct Patient Care. Teaching that is unrelated to Direct Patient Care is not payable as Indirect Patient Care Time

Clinical Administration Time (Q313A) includes:

  • Proactive patient management and review for screening interventions, disease management, and provision of care (example: mammograms, colon cancer screening, immunizations, diabetes management)
  • Electronic Medical Record (EMR) updating and management that requires physician expertise
  • Quality improvement planning and clinic-based implementation work including but not limited to planning and implementing patient access and equity initiatives and training and change management associated with the adoption of digital health-driven solutions and initiatives

Clinical administration does not include time spent on non-clinical administration related to clinic management: management of employees, finance and accounting responsibilities, ordering supplies and equipment, and clinic infrastructure services such as leasing and insurance.

Keywords/Tags

Physician Services Agreement; PSA; physicians; FHO; Hourly Rate; Q310A; Q311A; Q312A; Q313A

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.