In an unprecedented move, the MOH has increased the fees payable by hefty margins, that adds tremendous value to the ICHSC clinics.
There never is better time to purchase an Imaging Centre in Ontario !!
Please read the MOH bulletin below.
(MOH Webpage: Bulletin 250401 — Updates to Fee Schedule Master | OHIP INFOBulletins 2025 | ontario.ca)
Changes to fee codes on April 1, 2025.
To: All Physicians
Category: Physician services, Community surgical and diagnostic centres
Written by: Claims Services Branch, Health Programs and Delivery Division
Date issued: March 31, 2025
Bulletin Number: 250401
The Ministry of Health (the ministry) and the Ontario Medical Association (OMA) have been working together to implement physician compensation increases in accordance with the Arbitration Award (Award) for Year 1 of the 2024-2028 Physician Services Agreement (PSA).
The value of Fee Schedule Codes (FSCs) will revert to the rates listed in the Schedule of Benefits (Schedule) for claims with a service date on or after April 1, 2025. Please refer to the Schedule available on the Ministry of Health’s website at OHIP Schedule of Benefits and fees under Schedule of Benefits for Physician Services for current FSC values.
The updated fee schedule master file is expected to be available on the Ministry of Health’s website at OHIP Schedule of Benefits and Fees under the Fee Schedule Master section by April 4, 2025.
Additional information regarding ongoing implementation of the Year 1 Award for the period of April 1, 2025 going forward will be provided in a subsequent INFOBulletin.
Fineprint:
METHOD FOR THE IMPLEMENTATION OF 2025/26 FFS COMPENSATION INCREASES IN THE MINISTRY OF HEALTH (MINISTRY) AND ONTARIO MEDICAL ASSOCIATION (OMA) YEAR 3 2021 PHYSICIAN SERVICES AGREEMENT AND YEAR 1 2024 PHYSICIAN SERVICES AGREEMENT
The interim relativity-adjusted increase to physician payments for FY 2025/26 as set out in the OMA and Ministry of Health 2021-24 PSA Year 3 Implementation and 2024-28 Procedural Agreement dated February 22, 2024 (the “Year 3 Agreement”), and the Binding Interest Arbitration Award dated September 12, 2024 (the “Award”), and the Supplementary Year 3 and Year 1 Implementation Agreement between the Ministry and OMA dated October 25, 2024 (with respect to the implementation of relativity-adjusted payment increases) were arrived at by:
1. Identifying insured Fee-For-Service (FFS) payments that are eligible to receive the 9.96 percent compensation increase arising from the Year 3 Agreement and the Award for FY 2025/26 (the compounded value of 2.8% from the Year 3 Agreement and 6.965% representing 70% of the 9.95% increase from the Award);
2. Determining the derived specialty of each physician; and
3. Determining the relativity increase rate.
(1) Eligible payments in FY2025/26
a) Increases shall be applied to the basic fee payable for an insured service, as set out in the schedule of benefits, except hospital technical fees.
b) Increases will be applied based on service date and will apply to services rendered on or after April 1, 2025 and before April 1, 2026.
(2) Assigning a derived specialty for each physician
a) A derived specialty is assigned based on physician billings for FY 2024/25. Derived specialty is the billing specialty associated with the claims for insured services submitted by the physician that had the highest total billings (paid and shadow billed) unless the exception listed below applies. NOTE: Physicians who did not have claims in FY 2024/25 will initially be assigned the 9.96 percent global rate until a derived specialty can be determined based on their 2025/26 claims.
b) Family & General Practice has three different derived specialties: 00_1 Capitation, 00_2 FFS, 00_3 Salary and Contracts.
(1) The 00_1 specialty is applied to ‘00’ physicians who are affiliated to a capitated model. (see Table 2 for additional details)
(2) The 00_2 specialty is applied to ‘00’ physicians who receive fee for service (FFS) payments including Family Health Group (FHG), Comprehensive Care Model (CCM) and other FFS payment models. Additionally, the 00_2 specialty is applied to ‘00’ physicians who receive payments from contract models (e.g. Academic Comprehensive, Academic Specialty, AHSC, Community, Northern Specialists, and Family Medicine programs such as Locum, UAP, and Physician Collaboration). (see Table 2 for additional details)
(3) The 00_3 specialty is assigned to ‘00’ physicians who receive payments from primary care salary and contract models. (see Table 2 for additional details)
c) The Emergency Medicine specialty is applied to physicians who have:
(1) a derived specialty of ‘12’ (Emergency Medicine),
(2) a derived specialty of ‘00’ (Family & General Practice), are not in a primary care model (PCM) (relevant PCMs: FHN, FHO, GHC, CCM, FHG, BSM, RNPGA, STJHC, GPFCOE, GPHIV, WAHA, AFHT, CHC, GPFPC, IPHCO, TPCA, HSA, or SIOUX) and are affiliated with an Emergency Department Alternative Funding Agreement (EDAFA) group (excluding GP Experts and Second Oncall) and received payment for at least one claim under their affiliated group,
(3) a derived specialty of ‘00’ (Family & General Practice), are not in a PCM (as above), are not affiliated with an EDAFA group (excluding GP Experts and Second On-call), and whose FFS is predominantly (>50 percent) for emergency department services (relevant H-prefix codes: ‘H065’, ‘H100’, ‘H101’, ‘H102’, ‘H103’, ‘H104’, ‘H105’, ‘H112’, ‘H113’, ‘H121’, ‘H122’, ‘H123’, ‘H124’, ‘H131’, ‘H132’, ‘H133’, ‘H134’, ‘H151’, ‘H152’, ‘H153’, ‘H154’, ‘H960’, ‘H962’, ‘H963’, ‘H964’, ‘H980’, ‘H981’, ‘H984’, ‘H985’, ‘H986’, ‘H987’, ‘H988’, ‘H989’).
d) The Critical Care Medicine specialty is applied to physicians who have: (1) a derived specialty of ‘11’ (Critical Care Medicine), (2) whose FFS is predominantly (> 50 percent) in critical care per diem fee codes (relevant G-prefix codes: ‘G400’, ‘G401’, ‘G402’, ‘G405’, ‘G406’, ‘G407’, ‘G557’, ‘G558’, ‘G559’).
e) Physicians with new Palliative Medicine derived specialty will be assigned the 9.96 percent global rate.
f) A physician may only be assigned one derived specialty. For ‘00’ physicians who receive payments through various payment models, the following is the order of assignment of derived specialty: 00_1, 00_2 CCM/FHG , 00_3, Emergency Medicine, 00_2 contract models, Critical Care Medicine, 00_2 FFS.
(3) Determining relativity increase rate for each payment category
a) The relativity increase rates are set out in Table 1 and will be applied as set out below. These rates are cumulative, taking into account the 2.8 percent increase from Year 3 of the 2021 PSA and the 6.965 percent increase from Year 1 of the 2024 PSA.
(1) The basic fee payable for an insured service, as set out in the schedule of benefits (excluding hospital-based technical and office-based technical fees) will receive an increase based on the individual physician’s derived specialty.
(2) Office-based technical fees will receive the global increase rate, regardless of the individual physician’s derived specialty.
(3) Hospital-based technical fees are excluded and will not receive an increase.
(4) Calculate payments
a) The basic fee payable for an insured service, as set out in the schedule of benefits, will be multiplied by the appropriate relativity increase rate [set out at 3 and as 2 of 6 detailed in Table 1 and Table 2] for services rendered on or after April 1, 2025 and before April 1, 2026.
b) Increases will be applied to all eligible payments [set out at 1 and 3] on a monthly basis, except hospital technical fees, and will be flowed to the recipient in the usual manner (e.g. to individual physicians, group, contract, or institution).
