Compensation Increases, New Diagnostic Codes, and What Your Practice Must Do Now
April 1, 2026 brought the most significant OHIP billing update in years for Ontario physicians. New PSA compensation rates are now flowing — a compounded 5.37% increase for Years 2 and 3 of the 2024–28 agreement. At the same time, MOH Bulletin 260314 updated 43 diagnostic codes: two new codes were added, two were permanently deleted, and 41 descriptions were revised. If your billing team hasn’t been briefed, rejected claims and missed revenue are already possible.
Context
- The 2024–28 PSA arbitration awarded physicians a total 7.3% increase over Years 2–4 (2.8% + 2.5% + 2.0%). Years 2 and 3 are being paid simultaneously on an interim basis from April 1.
- The compounded 5.37% applies to fee-for-service billings AND automated payments (capitation, premiums, salaries).
- Separately, the temporary relativity-adjusted increases from Year 1 are now replaced by permanent fee code adjustments — meaning specific codes are being repriced, not just a flat rate applied.
- MOH Bulletin 260314 (issued March 13, 2026) is part of the MOH/OMA joint effort to modernize OHIP diagnostic code descriptions.
What This Means for Your Practice
On the PSA Compensation Side:
- Fee-for-service payments received a 5.37% increase for services rendered April 1, 2026 to March 31, 2027.
- Automated payments (capitation, premiums, salaries) also updated — check your MCPS statements.
- The Year 1 temporary relativity increase is gone; it has been replaced by targeted permanent fee code adjustments in priority areas. This means some codes will see higher-than-5.37% increases while others may be less — billing staff should review the new fee schedule.
On the Diagnostic Code Side:
- Code 100 (Venereal Diseases) — DELETED. Claims using this code will be rejected. Remove from all EMR templates immediately.
- Code 903 (Social, Marital and Family Problems: Illegitimacy) — DELETED. Same risk. Remove now.
- Code 308 — New code for Gender Dysphoria. Now available for applicable patients.
- Code 489 — New code for RSV (Respiratory Syncytial Virus). Relevant for family physicians and pediatricians especially.
- 41 other codes have revised descriptions. These won’t cause rejections automatically but staff should review to ensure clinical documentation matches updated terminology.
What You Should Do
- ACTION 1: Audit your EMR billing templates today — remove codes 100 and 903 from all drop-down lists, quick-pick menus, and macros.
- ACTION 2: Add codes 308 and 489 to your EMR if they are relevant to your patient population.
- ACTION 3: Confirm your billing software or MCPS statements reflect the new 5.37% interim rate for April billings.
- ACTION 4: Review any claims submitted since April 1 that used the old temporary relativity rate — flag for reconciliation once permanent adjustments are published.
- ACTION 5: Forward the updated diagnostic codes document (linked in the MOH bulletin) to all billing staff and clinicians for review.
How MAP Can Help
MAP’s OHIP billing team monitors every MOH InfoBulletin and PSA update proactively, so your practice is always compliant before a bulletin’s effective date — not after a claim is rejected. We handle the audit, the EMR updates, and the reconciliation.
