Bulletin 260310 — Update: 2026-27 schedule of benefits for laboratory services
Update to the Schedule of Benefits for Laboratory Services (SOB-LS) effective April 1, 2026
To: Ordering Clinicians (Medical Practitioners, Registered Nurses in the Extended Class, as applicable pursuant to Ontario Regulation 45/22 under the Laboratory and Specimen Collection Centre Licensing Act)
Category: Physician Services, Primary Health Care Services, Registered Nurse in the Extended Class, Midwife services
Written by: Laboratories and Diagnostics Branch, Health Programs and Delivery Division
Date issued: April 20, 2026
Bulletin Number: 260310
Overview and Program Changes Effective April 1, 2026
The laboratory services that are insured under the Ontario Health Insurance Plan (OHIP) are set out in the Schedule of Benefits for Laboratory Services (SOB-LS) under Regulation 552 of the Health Insurance Act. The Ministry of Health has made the following changes to the SOB-LS effective April 1, 2026:
- Transition 10 laboratory tests that were previously publicly funded under the Community Access Pilot to the SOB-LS as OHIP-insured laboratory services.
- Update the fee listed in the SOB-LS for L354 Free PSA and L358 Total PSA, to allow payment via the ministry’s transfer payment agreement for OHIP insured laboratory services.
In addition to the SOB-LS changes above, the following change to the OHIP claims system is effective April 1, 2026:
- The Human Papillomavirus (HPV) Screen test that went live with the Ontario Cervical Screening Program (OCSP) effective March 3, 2025, has been added to the claims system for shadow billing purposes, similar to L699 and L734.
Claims processing changes
OHIP claims system updates have been implemented to support the program changes outlined above.
Transition of Community Access Pilot Tests to the SOB-LS
Ten laboratory tests that were publicly funded under the Community Access Pilot have transitioned into the SOB-LS as OHIP-insured laboratory services effective April 1, 2026. Nine fee codes have been created for the 10 laboratory tests. Table of Services Transitioned to SOB-LS outlines the tests now available in the SOB-LS.
Any ordering clinician in Ontario, as defined for specimen collection and laboratory testing in Ontario Regulation 45/22 under the Laboratory and Specimen Collection Centre Licensing Act, can request services included in the SOB-LS by using the existing ordering practices that are currently in-place. Clinicians can also continue their current practices when completing the requisition for tests listed in the table.
The ordering clinician should only refer patients to have their specimens collected at a community laboratory according to the criteria in the table.
The updated SOB-LS is effective April 1, 2026, and is available on Ontario.ca. Further information on the 2026-27 Community Access Pilot for Laboratory Services will be communicated in a future INFOBulletin.
Table of Services Transitioned to SOB-LS
| New Fee Code | Test Name | New Fee Amount | Clinical Indications for Ordering |
|---|---|---|---|
| L657 | Trichomonas – Nucleic Acid Amplification Test (NAAT) | $18.75 | Polymerase Chain Reaction (PCR) test (NAAT) only – no changes to existing clinical guidance. |
| L619 | Gonorrhea/Chlamydia (NAAT) | $24.00 | PCR test (NAAT) only – no changes to existing clinical guidance. Order Gonorrhea/Chlamydia tests together. |
| L675 | C. difficile-EIA stool antigen and Toxin A/B | $53.00 | Enzyme Immunoassay (EIA) as initial screen. If EIA stool antigen and Toxin A/B test is positive for toxin, L676 C. difficile – Confirmatory (NAAT) cannot be claimed. |
| L676 | C. difficile-Confirmatory (NAAT) | $42.25 | NAAT for confirmatory testing only |
| L042 | Apolipoprotein B | $18.00 | As per the 2021 Canadian Cardiovascular Society (CCS) Guidelines |
| L043 | Lipoprotein a [Lp(a)] | $24.75 | As per the 2021 Canadian Cardiovascular Society (CCS) Guidelines |
| L570 | Celiac tissue Transglutaminase Immunoglobulin A (tTG-IgA) | $17.50 | Should be ordered for the diagnosis of celiac disease only with the following criteria:
|
| L571 | Celiac serum IgA (Immunoglobulin A) | $1.50 | Used alongside Celiac tTG-IgA (Celiac tissue Transglutaminase Immunoglobulin A) when medically necessary to confirm whether a client is IgA (Immunoglobulin A) deficient. When L571 Celiac serum IgA is billed, L550 (Single gel diffusion and nephelometric quantitative assays) should also be billed for the service. L550 is not insured as part of celiac testing unless L570 Celiac tTG-IgA and L571 Celiac serum IgA are both claimed. |
| L344 | N-Terminal-pro hormone B-type Natriuretic Peptide (NT-proBNP) | $30.00 | Clinically indicated and insured only in clients with suspected heart failure. |
Community Access Pilot Tests
- If approved, the new Fee Schedule Codes (FSCs) will be approved at the values listed in Table 1 and paid at zero dollars ($0) with explanatory code I2 – Service is globally funded.
- If the new FSC is billed with a service date prior to April 1, 2026, the claim will reject to the Error Report with error code A3E – No such service code for date of service.
- If the new FSC is billed with a blank or ineligible referring number, the claim will reject to the Error Report with error code V09 – Invalid Referral Number.
Human Papillomavirus (HPV) testing under the Ontario Cervical Screening Program (OCSP).
As part of the Ontario Cervical Screening Program (OCSP), the following tests will be added or changed in the OHIP claims system:
Human Papillomavirus (HPV) screen testing (new test to be introduced to the OHIP claims system), effective April 1, 2026.
| New Fee Code | Test Name | New Fee Amount |
|---|---|---|
| L698 | Human Papillomavirus (HPV) Screen | $0.00 |
Fee Code Description Changes.
- L699 – Name/Description Change:
- Current Description: Human Papillomavirus Testing
- New Description: Human Papillomavirus (HPV) Variant.
- L699 should only be claimed if L698 has yielded a positive result.
L698
Approved L698A will be accompanied with the following explanatory code:
- LA – Lab service is funded by special Lab Agreement
Changes to the fees for Prostate Specific Antigen (PSA) testing under the SOB-LS
The fee changes in the SOB-LS are administrative and will streamline billing and payment processes for the community labs. There is no change to funding or eligibility for OHIP insured PSA testing as a result of this update.
| Fee Code | Test Name | New Fee Amount |
|---|---|---|
| L354 | Prostate Specific Antigen (PSA), Free | $9.50 |
| L358 | Prostate Specific Antigen (PSA), Total | $9.50 |
L354A and L358A
- For claims with a service date prior to April 1, 2026, L354A and L358A will continue to approve at $0 with explanatory code ‘LA’.
- For claims with a service date on or after April 1, 2026, L354A and L358A will approve at $9.50 with explanatory code ‘I2’.
Additional information
For further information about the updated Schedule of Benefits for Laboratory Services, please email or call
Keywords/Tags
Schedule of Benefits for Laboratory Services; Community Laboratories; Laboratory Services; Patient Access
Contact Information
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