Bulletin 261102 — New patient and attachment bonus fee schedule codes

New patient attachment bonuses and new patient fees available to eligible physicians effective July 1, 2025

To: Eligible Patient Enrolment Model (PEM) Physicians, Comprehensive Care Model (CCM), Family Health Group (FHG), Family Health Network (FHN), Family Health Organization (FHO), Blended Salary Model (BSM), Group Health Centre (GHC), St. Joseph’s Health Centre (SJHC), Weeneebayko Area Health Authority (WAHA), Rural and Northern Physician Group Agreement (RNPGA), GP Focus HIV (GPHIV), GP Focus Care of the Elderly (GPCOE1), Sioux Lookout Regional Physician Services Incorporated (SLRPSI), Rural Generalist Model (RGM)  
Category: Primary Health Care Services
Written by: Physicians Relations and Contract Oversight Branch 
Date issued: November 2, 2026 
Bulletin Number: 261102

Overview

The Ministry of Health (the ministry) and the Ontario Medical Association (OMA) continue to work together to implement physician compensation changes under the 2024-2028 Physician Services Agreement (PSA).

Effective July 1, 2025, new Fee Schedule Codes are introduced for eligible Patient Enrolment Model (PEM) physicians to support enrolment of unattached patients:

• Q027A Patient Attachment Bonus Established Doctors
• Q037A Patient Attachment Bonus New Graduate
• Q051A Mother Newborn New Patient Fee
• Q052A Multiple/Newborn New Patient Fee
• Q058A HCC Complex/Vulnerable Unattached New Patient Fee

The new fees will be claimed through the regular OHIP claims submissions processes and may be billed retroactive to July 1, 2025.  All New Patient Fee or Attachment Bonus claims may be submitted starting November 1, 2026.

These new bonuses and fees are in addition to existing attachment codes such as Q023A for Unattached Patient from Hospital Fee or Q043A for New Patient Fee Fecal Immunochemical Test (FIT) Positive/Colorectal Cancer (CRC) Increased Risk. Physicians can refer to appendix C to assess eligibility. Please note only one attachment code or new patient fee is payable per patient.

Effective July 1, 2025, relativity has been included in the fee value of the new patient attachment bonus and new patient fee codes, including Q053A. Therefore, relativity will not be calculated and paid separately for these codes. Q023A and Q043A will continue to be eligible for separate relativity payments based on the service date of the claim.

General eligibility requirements

The physician must satisfy the general eligibility requirements including:

• The patient is new to the physician and the physician’s group.
• The patient and physician complete the necessary forms attesting to the patient being unattached.
• The physician follows the additional general claim rules.

The physician must also meet the specific eligibility rules for the applicable bonus or fee set out in this bulletin.

1. Patient is new to the physician and group

A patient attachment bonus or new patient fee may only be paid once per patient per group.

A patient who has previously generated a patient attachment bonus or new patient fee payment in respect of a group is not eligible for an additional bonus or payment for that same group, including where there has been a significant gap in time or a subsequent re-enrolment to that group.

Furthermore, if a patient was previously enrolled to a group but the group did not submit a claim for a patient attachment bonus or new patient fee in respect of that patient, the group may not subsequently submit a claim in respect of that patient. The payment is not available where the patient was previously enrolled with the group.

A patient is not eligible for a patient attachment bonus or new patient fee where:

• The patient is currently enrolled to, or has previously been enrolled to, the physician.
• The patient is currently enrolled to, or has previously been enrolled to, another physician in the same group.
• The patient was transferred to the physician from another physician in the same group.
• The patient was transferred with the physician from one group to a new group.
• The patient is a newborn whose mother is enrolled to the physician.
• The patient has a family physician in their community and is enrolling to the physician (including those who had a fee-for-service family physician).

2. Confirm patient’s unattached status by completion of required forms

Patients must complete both:

1. the Primary Health Care New Patient Declaration form; and
2. the Patient Enrolment and Consent to Release Personal Health Information form.

The new patient form asks the patient to declare they do not have a family physician due to one of the following circumstances:

• The patient’s previous family physician has moved to another community.
• The patient has moved to another community.
• The patient’s previous family physician is no longer available to due illness/death/retirement.
• The patient’s previous family physician is no longer available due to change of practice.
• The patient has not had or felt the need to have a family physician.

The new patient form also requires the physician to attest that the patient is new to that physician, and to the best of the physician’s knowledge, new to the group.

Physicians are not required to undertake investigation beyond the information available to them and the declarations provided by the patient. However, completion of the forms alone does not establish eligibility for a patient attachment bonus or new patient fee or create an entitlement to a bonus or fee if all the requirements in this bulletin are not otherwise met.

Forms should be signed and dated by the patient at the first available opportunity upon or after enrolment. Forms may be completed electronically.

Copies of the completed forms must be kept in the patient’s chart and do not need to be submitted to the Ministry unless requested for audit purposes.

3. Additional general claim rules

• The patient must be enrolled to the physician using the appropriate enrolment code (e.g., Q200A) on or after July 1, 2025.
• Fees submitted for patients enrolled prior to July 1, 2025, will be paid at $0 with the payment explanatory code “IG – Service Date Ineligible”.
• The patient must be enrolled to the billing physician on the service date associated with the new fee being claimed.
• Only one attachment code per patient can be billed, if two are submitted (e.g., a patient attachment bonus code and a Health Care Connect (HCC) attachment code) the Ministry will pay the first one processed.
  • When a physician bills the same patient attachment bonus or new patient fee code that has already been paid for the same patient using a different service date, the claim will pay at $0 with payment explanatory code “M1 – Maximum Fee Allowed or Maximum Services Reached”.
• The patient attachment bonus and new patient fees are limited to one per patient and may only be claimed by one physician within the group in respect of each patient.
  • When the patient has a prior history of enrolment to the billing physician, or any other enrolling physician in the same PEM group, the claim will be paid at $0 with the payment explanatory code “IH – Prior Enrolment History Exists”
  • Claims submitted for non-enrolled patients will pay at $0 with the payment explanatory code “I6 – Premium not applicable”.
• When a claim is submitted, the ministry reviews the patient's enrolment history and any previous attachment incentive payments. If an attachment incentive has already been paid to you (or another physician in your PEM group) for that patient, a new claim will not be eligible for payment, even if it is submitted under a different fee code.
  • When a physician bills a different patient attachment bonus or new patient fee code for a patient where another attachment incentive fee has already been paid, the claim will reject to the physician's error report with error code “A3L – Other New Patient Fee Already Paid.”
  • When a physician bills a patient attachment bonus or new patient fee code for a patient where another attachment incentive fee has already been paid to a different physician in the same group, the claim will either reject to the physician's error report with error code “A36 – Claimed by Other Practitioner” or be paid at $0 with the payment explanatory code “IH - prior enrolment history exists”.
  • The following attachment incentive codes are assessed together when determining eligibility: Q013A, Q023A, Q027A, Q033A, Q037A, Q043A, Q051A, Q052A, Q053A, Q054A, Q055A, Q056A, Q057A, and Q058A (see appendix A for more details on these fee codes).
• If the physician chooses to de-enroll a new patient within 12 months of formal enrolment, the fee paid to the physician will be recovered (see Enrolment ends before 12 months section for more details).
• Income Stabilization (IS) physicians must submit new bonus or fee codes using their group number. IS physicians billing without a group number will reject to the physician’s error report “EPA – Network Billing Not Allowed.”
  • The ministry strongly encourages physicians who have an affiliation to multiple PEM groups (e.g., a signatory to one group and a locum affiliation to another group) to bill using their group number to ensure accuracy in adjudication of payments.
• A Locum physician is not eligible for a patient attachment bonus or new patient fee. When a locum physician who is part of a PEM Group bills an attachment bonus or new patient fee, the claim will reject to their error report with error code “EPA - Network Billing Not Allowed”.
• When a nurse practitioner who is part of a PEM Group bills an attachment bonus or new patient fee, the claim will reject to their error report with error code “ENP – Invalid FSC for Nurse Practitioner (NP)”.

General payment eligibility examples

Example 1a: Patient roster is transferred to another physician within the same PEM Group

Physician A received payment for a patient attachment bonus or new patient fee for Patient X.

Physician A transfers their roster to Physician B two years later.

Physician B submits a patient attachment bonus or new patient fee claim for Patient X.

Result:

• The claim for physician B is not eligible for payment because the roster transfer does not create a new attachment incentive opportunity.
• Prior enrolment history and previous attachment incentive payments continue to apply.
• The claim for physician B will either be paid at $0 with the payment explanatory code “IH - prior enrolment history exists” or reject to the physician’s error report with error code “A36 – Claimed by Other Practitioner”.

Example 1b: Patient roster transfer for same physician between different PEM Groups

Patient 1: The physician has a new patient for whom they have been paid an attachment bonus or new patient fee under group A.

Patient 2: The physician has another new patient for whom they did not submit an attachment bonus or new patient fee under group A.

The physician transfers from group A and moves to group B. The physician takes their roster with them to group B.

Result patient 1:

• The claim remains eligible for payment in group A. The physician is not eligible for another attachment bonus or new patient fee in group B. If the claim is submitted under group B, it will be paid at $0 with the payment explanatory code “IH-prior enrolment history exists”.

Result patient 2:

• The claim remains eligible for payment in group A. The physician is not eligible for another attachment bonus or new patient fee in group B. If the claim is submitted under group B, it will be paid at $0 with the payment explanatory code “IH-prior enrolment history exists”.

Specific code eligibility rules

1. New attachment bonus fee schedule codes

Q027A patient attachment bonus established doctors

Effective July 1, 2025, all PEM signatory physicians are eligible for the Patient Attachment Bonus Established Doctors Fee.

The fee ranges from $100 to $180 depending on the age of the patient and the Rurality Index for Ontario (RIO) Score of the physician or their group, whichever is higher.

Physicians can use the OMA RIO Postal Code Look-up to help estimate their RIO score based on their postal code. Physicians practicing in a postal code designated with a RIO score greater than or equal to 40 may want to verify they are registered correctly by checking their remittance advices to ensure they are also receiving eligible payments like the rurality gradient premium or the increased hospital special premium.

Q037A patient attachment bonus new graduate

Effective July 1, 2025, New Graduates who have joined a PEM within three (3) years of completing their family medicine residency, or International Medical Graduates (IMGs) who have completed family medicine post graduate training and obtained an independent practice licence, are eligible for the “Patient Attachment Bonus New Graduate Fee”. New graduate status remains valid for up to twelve months following entry into a PEM.

The fee ranges from $150 to $270 depending on the age of the patient and the Rurality Index for Ontario (RIO) Score. 

General billing rules for Q027A/Q037A

In addition to the general claim rules (above), for purposes of billing Q027A or Q037A:

• The patient attachment bonuses require a service visit billed on the same service date of the bonus. It may occur on or after the enrolment date (i.e., Q200A on July 1, 2025, or later). For greater clarity, the visit does not need to be the “first” visit. It can be a subsequent visit.

Example 2: Multiple in-person services on different service dates

An established physician submitted a Q200A in July 2025 to enroll a new patient with an effective date of July 1, 2025. The physician provided an A007A service to the patient on July 1, 2025. The physician also provided an A007A service to the patient on October 15, 2026.

This physician will be eligible to submit Q027A Patient Attachment Bonus Established Doctors using either a service date of July 1, 2025, or October 15, 2026.

Result:

• The physician’s claim will be paid where all other requirements are met.
• The visit must be an in-person visit in the usual family medicine clinical practice (i.e. not virtual).
• The in-person service may be Fee-For-Service or shadow billed.
• For patients enrolled up until the point the patient attachment bonuses are announced, you will need to back-date the service date for the patient attachment bonus to be the same service date as any insured service provided in the usual family practice setting, either on or after the date of enrolment. 

Notes

• When no in-person service visit is found, the claim will pay $0 with the payment explanatory code “DF – Corresponding fee code was not billed or paid at zero.”
• Physicians claim Q027A/Q037A fees at the “lowest fee value” and ministry systems will adjust the payments according to patient age and the physician’s RIO Score.
• If a new graduate physician bills a ‘Q027A Patient Attachment Bonus Established Doctors’, the claim will reject to the physician’s error report with error code ‘EQJ – Practitioner Not Eligible on Service Date’.
• If an established physician bills a ‘Q037A Patient Attachment Bonus New Graduate’, the claim will reject to the physician’s error report with error code ‘EQJ – Practitioner Not Eligible on Service Date’.
• Corrective action where no service code was submitted with Q027A/Q037A would include the following options for physicians:
  • Submit the insured in-person service and either resubmit the Q027A/Q037A or submit a Remittance Advice Inquiry to adjust the originally submitted Q027A/Q037A, or
  • Resubmit the Q027A/Q037A with the correct service date where an eligible insured service was previously billed.
• Q027A and Q037A will expire on March 31, 2028.

2. New patient fee schedule codes

Q051A – mother newborn new patient fee

This is a one-time $350 payment for enrolling both a mother and newborn (pair).

The physician must enrol both an unattached mother and newborn within two weeks of birth or an unattached pregnant patient after 30 weeks gestation.

• The fee is billed under the mother's health number.

The health number used on the claim must belong to a female patient. Claims submitted under a health number belonging to a patient who is not female will reject to the physician’s error report with error code “A2B – Wrong Sex for Service”

Q052A – multiple/newborn new patient fee

This is a one-time $150 payment for enrolling additional newborn (in the case of multiple births).

In cases of multiple births:

• Q051A may be billed for the mother/newborn pair.
• Q052A may be billed for each additional newborn.

Q052A must be billed under each additional newborn's health number.

Each newborn must be enrolled (i.e., Q200A submitted) to the billing physician within 90 days of birth.

Where enrolment has occurred more than 90 days after birth, the claim will be rejected to the physician’s error report with error code “HCE – Enrolment After 3 Mos.”. The Multiple/Newborn New Patient Fee cannot be claimed for a patient older than one year of age. The claim will be rejected to the physician's error report with error code "A2A – outside of age limit – patient is underage/overage for this service code” when the service date is greater than or equal to 12 months from the newborn’s date of birth.

Q058A HCC complex/vulnerable unattached new patient fee

This is a one-time $500 payment for enrolling a patient through Health Care Connect (HCC), subject to the overall eligibility criteria.

Q058A may be billed for either of the following situations:

• the enrolled patient has been identified by HCC as complex/vulnerable.
• although the enrolled patient was not identified by HCC as complex/vulnerable, based on their clinical judgment, the physician determines that the patient is complex/vulnerable.
  • Physicians must retain documentation in the patient's medical record to support the complex/vulnerable designation.

Notes on Health Care Connect fee code

• Transition from Q053A to Q058A: Beginning November 1, 2026, Q058A replaces Q053A for all future eligible HCC-based complex/vulnerable enrolments. Q058A may also be submitted retroactively with qualifying service dates on or after July 1, 2025.

Key service dates:

• Fee Increase for New Unattached Patient Fee – Health Care Connect (HCC) Complex/Vulnerable Patient. As of November 1, 2026, the fee value for the Q053A has been increased to $500 retroactive to July 1, 2025. All previously paid Q053A claims will be adjusted by a Medical Claims Adjustment (MADJ) processing at a future date to pay the increased amount per claim ($150.00). Any previously paid relativity amounts for claims paid with service dates on or after July 1, 2025, will be reconciled and recovered. No action is required by the physician.

Enrolment ends within 12 months

Patient attachment bonus and new patient fee payments are intended to support long-term patient attachment. When a patient is de-enrolled by the enrolling physician or the group before completing 12 months of continuous enrolment, the patient attachment bonus fee will be recovered and payment explanatory code “ID – Physician De-Rostered patient” will be applied.

A roster transfer does not restart the 12-month retention period associated with attachment incentive recovery rules. The ministry continues to use the patient's original enrolment date when assessing whether recovery applies. If the patient remains enrolled for 12 months from the original enrolment date, the attachment incentive remains payable when the transfer occurs between physicians in the same PEM Group or the same physician between two PEM groups.

If your claim is adjusted with explanatory code “ID – Physician De-Rostered patient” you can take the following steps to determine whether the patient completed 12 months of continuous enrolment:

• Review of the patient’s enrolment history.
• Confirm the original enrolment date.
• Confirm the de-enrolment date and term code.

Examples

Example 3a: De-enrolment before 12 months

An attachment incentive is paid to the enrolling physician. The physician or group de-enrols the patient using the Q402A before 12 months of continuous enrolment are completed.

Result:

• The claim will be adjusted to $0.00 with explanatory code “ID – Physician De-Rostered patient”, and the original payment will be recovered.

Example 3b: Roster transfer followed by de-enrolment

An attachment incentive is paid to physician A. The roster of physician A is transferred to physician B in the same PEM group. The patient is de-enrolled by physician B using Q402A before completing 12 months of enrolment from the original enrolment effective date with physician A.

Result:

• The claim will be adjusted to $0.00 with explanatory code “ID – Physician De-Rostered patient”, and the original payment will be recovered from Physician A.

Example 3c: Roster transfer to a different physician in a different PEM group

An attachment incentive is paid to physician A. The roster of physician A is transferred, before completing 12 months of enrolment, to physician B in a different PEM group.

Result:

• The claim will be adjusted to $0.00 with explanatory code “ID – Physician De-Rostered patient”, and the original payment will be recovered from Physician A. 

Example 3d: Roster ended by the group/physician

An attachment incentive is paid to physician A. The roster of physician A is ended by request of the group and/or physician. Patient enrolments are ended as of the requested date.

Result:

• Patients de-enrolled before completing 12 months of enrolment from the original enrolment effective date will have any previously paid attachment incentives adjusted to $0.00 with explanatory code “ID – Physician De-Rostered patient”, and the original payment will be recovered from the physician.

Retroactive claims submissions for patients enrolled from July 1, 2025 - October 31, 2026

Beginning November 1, 2026, until the May 2027 claims processing cut-off, physicians may retroactively submit eligible new fee codes with service dates from July 1, 2025 - October 31, 2026, and regular stale date rules will not be applied to these services. These stale date exemptions will apply to claims submitted before the May 2027 claims processing cut-off.

If a physician does not already have a completed Primary Health Care New Patient Declaration Form for a patient enrolled between July 1, 2025 - October 31, 2026, physicians have 12 months from November 1, 2026, to obtain one from eligible patients. Failure to obtain the form before submission will not affect payment eligibility, provided the form is completed and retained within the 12-month grace period.

Enrolments on or after November 1, 2026, are subject to the existing 3-month claim submission period timeframe per existing policies outlined in the Education and Prevention Committee Billing Briefs: Claim Submission Periods.

Appendix A: All new patient fees and attachment bonus incentives (existing, new, ended)

Existing and new fee schedule codes

*Fee is ended October 31, 2026

Previously ended fee schedule codes

Appendix B: New explanatory codes

New explanatory codes

Appendix C: Existing unattached new patient fees

Unattached Patient from Hospital Fee (Q023A)

A $150.00 premium will be paid for enrolling acute care patients previously without a family Physician.

Criteria for Unattached Patients from Hospital fee:

1. At the time of enrolment the patient did not have a family Physician, and they have had an acute care in-patient stay within the previous three (3) months.
   • An acute care in-patient stay is a stay of at least one night in hospital as an in-patient for an acute illness. Emergency department visits and day surgery stays do not qualify.
   • Newborns are eligible for the Unattached Patient Fee only if the mother does not have a family Physician and the newborn has been admitted to a Level II or higher Neonatal Intensive Care Unit (NICU) within the last three (3) months.
     1. The payment of this incentive is subject to the Physician accepting responsibility for providing comprehensive care for the patient by enrolling the patient and complete the Unattached Patient Declaration and
     2. the Enrolment and Consent form
2. The above forms must be completed within three (3) months of discharge from the in-hospital visit. The Physician must keep the Patient Declaration on file.

This fee is not allowed in addition to any other Attachment Bonus or Unattached Patient Fee. Subsequent claims will be rejected to the Claims Error Report with error code ‘A3L – Other new patient fee already paid.’

A Physician must submit for both an Unattached Patient from Hospital Fee (Q023A) and the enrolment code (Q200A) for the same patient. The Q023A and the Q200A must be submitted on the same claim with the same service date.

The Unattached Patient from Hospital Fee is allowed once per patient. There is no maximum number of patients.

Q043A New Patient Fee FIT Positive/Colorectal Cancer (CRC) Increased Risk

May be claimed for enrolling a new unattached patient through the Colon Cancer Check program; patient with an abnormal FIT result or at increased risk of CRC.

• $150 for patients up to and including 64 years of age
• $170 for patients 65 – 74 years of age, and
• $230 for patients 75 years of age and older

A Physician may submit for both a New Patient Fee (Q043A) and an enrolment code (Q200A) for the same patient. The Q043A and the Q200A must be submitted on the same claim with the same service date.

The service date of a Q043A claim must be the same as the date on the enrolment/consent form and the New Patient Declaration form.

This fee is not allowed in addition to any other Attachment Bonus or Unattached Patient Fee. Subsequent claims will be rejected to the Claims Error Report with error code ‘A3L – Other new patient fee already paid.’

Keywords/tags

PSA; patient attachment bonus; new patient fee; Q023A; Q027A; Q037A; Q043A; Q051A; Q052A; Q053A; Q058A; primary care; patient enrolment model; Health Care Connect

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.