April 1, 2026 was the most significant payday recalculation in Ontario family medicine in years. New billing codes went live. Premiums jumped. Compensation increases rolled across nearly every primary care model. But here is the problem: most of these changes require your practice to actively do something to capture the money. Some of it flows automatically and you just need to verify it showed up correctly. Some of it requires new codes your billing team may not be submitting yet. And one of them has a June 2026 deadline that, if missed, means that revenue is gone permanently. This article walks through the five most important changes, by model, so your practice does not leave money on the table.
Context
April 1, 2026 marked Year 2 of the 2024 Physician Services Agreement between the Ontario Medical Association and the Ministry of Health. The PSA is a four-year deal that reshaped how Ontario family physicians are compensated, and the April 2026 changes represent the largest single tranche of those improvements. If you missed our earlier article on what FHO+ is and how the model works, start there first. This article assumes you understand the basic model structure and focuses entirely on the billing and revenue capture side.
What This Means for Your Practice
1. FHG Physicians: Your Comprehensive Care Premium Just Increased From 10% to 15%
This one is automatic, which is good. But automatic does not mean guaranteed — it means you need to verify it showed up.
Effective April 1, 2026, the Family Health Group Comprehensive Care premium increased from 10% to 15% on all eligible fee-for-service services provided to your enrolled or assigned patients. Services billed on or after April 1 should be appearing on your Remittance Advice at 115% of the regular fee schedule rate, not 110%.
What to do: Pull your April 2026 Remittance Advice when it arrives and spot-check a sample of eligible services. The payment should reflect the 115% rate. If it does not, contact the Service Support Contact Centre at 1-800-262-6524.
One more thing worth noting now: effective April 1, 2027, this premium increases again, from 15% to 20%. That means by next year, FHG physicians will be receiving 120% of the standard fee-for-service rate on eligible services. If you are on the fence about whether your FHG model is still working for your practice, that number is worth factoring into your planning.
Source: MOH Bulletin 260315
2. FHO Physicians: You Have Four New Billing Codes and a Hard Daily Cap
If your practice has not yet started submitting the new FHO hourly rate codes, you are leaving significant money behind every week.
Effective April 1, 2026, FHO physicians can submit the following hourly codes through the Medical Claims Payment System (MCPS):
- Q310A — Direct Patient Care (In-Person or Video): $80 per hour ($20 per 15-minute unit) for time spent providing clinical services in-person or synchronous virtual care, in-office or out-of-office.
- Q311A — Direct Telephone-based Patient Care (Not in Office): $68 per hour ($17 per 15-minute unit) for telephone-based virtual care when you are not physically at your clinic location.
- Q312A — Indirect Patient Care: $80 per hour for work that does not involve direct patient contact but is patient-specific, including reviewing labs and imaging, preparing referrals, chart review, care coordination, and conferencing with specialists or other providers.
- Q313A — Clinical Administration Time: $80 per hour for administrative work that is not patient-specific but requires physician-level expertise, such as practice-level management for your roster.
The billing rules matter here. Leave the health number, version code, and birthdate fields blank on hourly code claims — populated fields will cause automatic rejections. The service date must reflect the actual date the work was performed. Locum physicians must bill hourly codes using the FHO group number, not their own solo number. Income stabilization physicians are not eligible.
The caps are strict:
- Maximum 14 hours (56 units) per day across all hourly codes combined.
- Maximum 240 hours per 28-day billing cycle.
- Indirect patient care (Q312A) and clinical administration (Q313A) combined cannot exceed 25% of your total monthly hours billed.
- Clinical administration (Q313A) alone cannot exceed 5% of total monthly hours billed for direct and indirect care.
The documentation requirement is new. For the first time, FHO physicians need to track and record time spent on indirect care — reviewing labs, coordinating referrals, reading specialist notes. Practices that have not yet set up a time-tracking process are billing blind. The revenue opportunity is real, but it requires a workflow change to capture.
Source: MOH Bulletin 260309
3. FHN, BSM, CHC, and Other Model Physicians: Your Base Compensation Increased — Verify the Amounts
Effective April 1, 2026, the PSA delivered the following permanent base compensation increases:
- Family Health Network (FHN) and Group Health Centre (GHC): +11.7513% on base rate capitation and regular daily rate.
- Blended Salary Model (BSM), Community Health Centre (CHC), Aboriginal Family Health Team (AFHT), Indigenous Primary Health Care Organization (IPHCO), Rural and Northern Physician Group Agreement (RNPGA), and several other model types: +15.8105% on base payments, benefits, and sessional fees.
These increases should be reflected automatically in your April 2026 remittance. However, given the complexity of some of these payment structures — particularly for models with multiple payment elements — it is worth having someone on your billing team verify the numbers against what you expected.
For BSM and CHC physicians specifically, the increase also applies to locum remuneration and benefits payments, not just base salary. Review the full payment breakdown, not just the headline number.
Source: MOH Bulletin 260306
4. All PEM Physicians: The Preventive Care Bonus Window Is Open — Deadline Is June 2026
This is the one with the hard deadline, and it is the one most practices miss.
Starting March 31, 2026, physicians enrolled in a Patient Enrolment Model (PEM) — including FHO, FHG, FHN, BSM, CCM, GHC, and others — can submit claims for their 2025-26 cumulative Preventive Care Bonus. The window covers the period April 1, 2025 through March 31, 2026.
The relevant bonus categories for FHO physicians in this cycle are influenza immunization and childhood immunization. The colorectal cancer, mammography, and cervical cancer screening bonuses no longer apply to FHO physicians as of fiscal year 2024, per the PSA agreement. Physicians with fewer than 1,000 enrolled patients will have remaining bonuses prorated.
The deadline is the June 2026 claims processing cut-off date. Claims received after that date are not guaranteed to be processed for payment. The MOH has made clear that standard stale-dating rules apply.
What to do now: Locate your 2025-26 Target Population/Service Report (TPSR), which was sent electronically via MCEDT to your solo billing account. Review your eligible patient counts and the service levels achieved. Submit your bonus claims before the June cut-off. If you have not yet registered your solo billing number for MCEDT, do that first — you will not receive this report otherwise.
Source: MOH Bulletin 260401
5. FHO Physicians: After-Hours Premium Jumped From 30% to 50%
This change was part of the same FHO+ implementation that introduced the new hourly codes, but it is worth calling out separately because it applies to a specific list of service codes and requires your billing team to know which services qualify.
Effective April 1, 2026, the after-hours premium for FHO physicians increased from 30% to 50% on all relevant codes billed with a Q012. The relevant after-hours codes as of April 1, 2026 are: A001A, A003A, A004A, A007A, A008A, A888A, E089A, K005A, K013A, K017A, K030A, K033A, K130A, K131A, K132A, K133A, Q050A, Q888A.
If your practice provides after-hours care and your billing team is still calculating premiums at 30%, every one of those claims since April 1 is being underpaid. This is not a claim that auto-corrects — it requires your billing team to apply the correct premium at the time of submission.
Also effective April 1: the access bonus and outside use payments have ended for FHO physicians. The comprehensive care capitation (CC cap) also ended on the same date. If your billing software or team was still including these legacy payment types, they should be removed from your workflow now.
Source: MOH Bulletin 260308
What You Should Do
- Pull your April 2026 Remittance Advice and review it against the changes listed above for your specific model. Do not assume the increases were applied correctly — verify them.
- If you are an FHO physician, confirm that your billing team has started submitting Q310A, Q311A, Q312A, and Q313A codes. If they have not, start immediately — this revenue is not retroactive beyond what you can document.
- Set up a time-tracking workflow for indirect patient care. Even a simple log of daily indirect care time will put the Q312A revenue within reach.
- Locate your 2025-26 TPSR via MCEDT and plan your PCB submission before the June 2026 cut-off. Put the deadline on your calendar now.
- Confirm your after-hours billing team knows the new 50% premium applies and has the updated code list.
- If any of this is unclear, or if a review of your April remittance reveals discrepancies, contact the MOH Service Support Contact Centre at 1-800-262-6524 or reach out to MAP.