Update: Apr 2026 FHO+ In Basket codes
FHO+ still pays the capitation base rate for enrolled patients. Core (in-basket) claims also shadow-bill as a blended fee-for-service premium.
Schedule 2 codes pay 30% of the Schedule of Benefits fee. Schedule 2B procedures pay another 20% on the same claim, for 50% total. Both apply to enrolled patients, including patients who live in long-term care.
Schedule 2 — Core services (30%)
Fee codes included in the Base Rate payment at 30%. Codes that pay 50% are listed in Schedule 2B.
| Fee code | Description | Shadow billing |
|---|---|---|
| A001A | Minor Assessment | 30% |
| A003A | General Assessment | 30% |
| A004A | General Re-Assessment | 30% |
| A007A | Intermediate Assessment/Well Baby Care | 30% |
| A008A | Mini Assessment | 30% |
| A101A | Limited virtual care service - video | 30% |
| A102A | Limited virtual care service - phone | 30% |
| A110A | Periodic Oculo-Visual Assess - aged 19 and under | 30% |
| A112A | Periodic Oculo-Visual Assess - aged 65 Years and over | 30% |
| A777A | Intermediate Assessment - Pronouncement of Death | 30% |
| A900A | Complex House Call Assessment | 30% |
| A917A | Focused Practice Assessment - Sport medicine | 30% |
| A927A | Focused Practice Assessment - Allergy | 30% |
| A937A | Focused Practice Assessment - Pain management | 30% |
| A947A | Focused Practice Assessment - Sleep medicine | 30% |
| A957A | Focused Practice Assessment - Addiction medicine | 30% |
| A967A | Focused Practice Assessment - Care of the elderly medicine | 30% |
| A990A | Special Visit to Office - Daytime - Weekdays | 30% |
| A994A | Special Visit to Office - Evenings - Saturday, Sunday or Holidays | 30% |
| A996A | Special Visit to Office - Nights | 30% |
| A998A | Special Visit to Office - Daytime - Saturday, Sunday or Holidays | 30% |
| B990A | Special Visit to Patient’s Home - Elective visit, regardless of time or day of week | 30% |
| B992A | Special Visit to Patient’s Home - Daytime - Weekdays - Emergency call with sacrifice of office hours | 30% |
| B993A | Special Visit to Patient’s Home - Daytime - Saturday, Sunday or Holidays | 30% |
| B994A | Special Visit to Patient’s Home - Evenings - Weekdays | 30% |
| B996A | Special Visit to Patient’s Home - Nights | 30% |
| C882A | Palliative care - Subsequent visits by the Most Responsible Physician | 30% |
| C903A | Pre-dental/pre-operative general assessment | 30% |
| G001A | Laboratory Medicine - Cholesterol Total | 30% |
| G002A | Laboratory Medicine - Glucose Quantitative or Semi Quantitative | 30% |
| G004A | Laboratory Medicine - Occult Blood | 30% |
| G005A | Laboratory Medicine - Pregnancy Test | 30% |
| G009A | Laboratory Medicine - Urinalysis - Routine Etc. | 30% |
| G010A | Laboratory Medicine - Urinalysis - One Or More Parts of G009A without Microscopy | 30% |
| G011A | Laboratory Medicine - Fungus Culture Including Koh & Smear | 30% |
| G012A | Laboratory Medicine - Wet Preparation (For Fungus, Trichomonas, Parasites) | 30% |
| G014A | Laboratory Medicine - Rapid Streptococcus | 30% |
| G123A | For each additional Paravertebral nerve block (see G228) | 30% |
| G197A | Allergy - Skin Tests - Professional Component | 30% |
| G202A | Allergy - Hyposensitisation | 30% |
| G205A | Allergy - Insect Venom Desensitisation | 30% |
| G209A | Allergy - Skin testing - technical component | 30% |
| G212A | Allergy - Hyposensitisation Injection Plus Basic | 30% |
| G223A | Somatic or peripheral nerves - additional nerve(s) or site(s) | 30% |
| G227A | Obturator nerve - Other cranial nerve block | 30% |
| G228A | Paravertebral nerve block of cervical, thoracic, or lumbar or sacral or coccygeal nerves | 30% |
| G231A | Somatic or peripheral nerves not specifically listed - one nerve or site | 30% |
| G235A | Somatic or peripheral nerves not specifically listed - Supraorbital | 30% |
| G271A | Anticoagulant Supervision | 30% |
| G310A | Electrocardiogram - twelve lead - technical component | 30% |
| G313A | Electrocardiogram - twelve lead - professional component | 30% |
| G370A | Bursa, joint, ganglion or tendon sheath and/or aspiration | 30% |
| G371A | Bursa, joint, ganglion or tendon sheath and/or aspiration - each additional site or area, to a maximum of 3 | 30% |
| G372A | Injections - Intradermal, Subcutaneous or Muscular - Additional | 30% |
| G373A | Injections - Intradermal, Subcutaneous or Muscular Basic Fee | 30% |
| G375A | Injection/Infusion - Intralesional Infiltration | 30% |
| G377A | Injection/Infusion - Intralesional Infiltration - 3 or more lesions | 30% |
| G379A | Injection/Infusion - Intravenous - Child or Adult | 30% |
| G381A | Chemotherapy - Single injection | 30% |
| G384A | Infiltration for Trigger Point | 30% |
| G385A | More Than One Site (Add to G384A) | 30% |
| G420A | Syringing and/or Extensive Curetting or Debridement | 30% |
| G435A | Tonometry | 30% |
| G481A | Laboratory medicine - Haemoglobin Screen and/or haematocrit - any method or instrument | 30% |
| G482A | Venipuncture - Child | 30% |
| G489A | Venipuncture - Adolescent or Adult | 30% |
| G525A | Diagnostic Hearing Test Professional Component | 30% |
| J301C | Simple Spirometry - Volume versus Time Study | 30% |
| J304C | Flow Volume Loop - Volume versus Flow Study | 30% |
| J324C | Simple Spirometry - repeat after bronchodilator | 30% |
| J327C | Flow Volume Loop - repeat after bronchodilator | 30% |
| K001A | Detention | 30% |
| K002A | Interviews with relatives or a person authorized to make a treatment decision | 30% |
| K003A | Interviews with Children’s Aid Society or legal guardian on behalf of patient | 30% |
| K004A | Family Psychotherapy - 2 or more Members | 30% |
| K005A | Primary Mental Health Care | 30% |
| K006A | Hypnotherapy | 30% |
| K007A | Psychotherapy | 30% |
| K008A | Diagnostic Interview with Child and/or Parent | 30% |
| K013A | Counselling - One Or More People | 30% |
| K015A | Counselling - Relative on behalf of patient | 30% |
| K017A | Periodic Health Visit - child after second Birthday | 30% |
| K130A | Periodic health Visit - adolescent | 30% |
| K131A | Periodic Health Visit - adult aged 18 to 64 inclusive | 30% |
| K132A | Periodic Health Visit - adult aged 65 years and above | 30% |
| K133A | Periodic Health Visit - Adults with Intellectual and Developmental Disabilities | 30% |
| K700A | Palliative Care out-patient case conference | 30% |
| K702A | Bariatric out-patient case conference | 30% |
| K730A | Physician to physician telephone consultation - Referring physician | 30% |
| K731A | Physician to physician telephone consultation - Consultant physician | 30% |
| K732A | CritiCall telephone consultation - Referring physician | 30% |
| K733A | CritiCall telephone consultation - Consultant physician | 30% |
| Q990A | Special Visit to non-professional setting - Daytime - Weekdays | 30% |
| Q992A | Special Visit to non-professional setting - Daytime - Weekdays - Emergency call with sacrifice of office hours | 30% |
| Q994A | Special Visit to non-professional setting - Evenings - Weekdays | 30% |
| Q996A | Special Visit to non-professional setting - Nights | 30% |
| Q998A | Special Visit to non-professional setting - Saturday, Sunday or Holidays | 30% |
| R048C | Malignant Lesions - Face or neck - Simple excision - single lesion - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| R051C | Laser surgery on Group 1-5 and malignant lesions - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| R094C | Malignant Lesions - Other areas - Simple excision - single lesion - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| Z128C | Simple, Partial or Complete, Nail Plate Excision Requiring Anaesthesia - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| Z129C | Simple, Partial or Complete, Nail Plate Excision Requiring Anaesthesia - Multiple - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| Z154C | Suture Of Lacerations - Up To 5cm - If on Face And/or Requires Tying of Bleeders And/or Closure in Layers - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| Z156C | Group 1 - Verruca, Keratosis, Pyogenic Granuloma - Removal by Excision and Suture - Single Lesion - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| Z157C | Group 1 - Verruca, Keratosis, Pyogenic Granuloma - Removal by Excision and Suture - Two Lesions - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| Z158C | Group 1 - Verruca, Keratosis, Pyogenic Granuloma - Removal by Excision and Suture - Three Or More Lesions - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| Z159C | Group 1 - Verruca, Keratosis, Pyogenic Granuloma - Removal by Electrocoagulation And/or Curetting - Single Lesion - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| Z160C | Group 1 - Verruca, Keratosis, Pyogenic Granuloma - Removal by Electrocoagulation And/or Curetting - Two Lesions - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| Z161C | Group 1 - Verruca, Keratosis, Pyogenic Granuloma - Removal by Electrocoagulation and/or Curetting - Three Or More Lesions - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| Z162C | Group 2 - Nevus - Removal by Excision and Suture - Single Lesion - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| Z175C | Skin - Suture - Laceration - 5.1 to 10cm - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| Z176C | Skin - Suture - Laceration - Up to 5cm - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| Z314C | Treatment Of Epistaxis - Cauterization - Unilateral - if the physician administered the anaesthetic for a procedure by another physician | 30% |
| Z611A | Catheterization - Acute Retention, Change of Foley Catheter or Suprapubic Tube or Instillation of Medication - Hospital | 30% |
Schedule 2B — Procedures with 50% total shadow billing
These are still core services. The extra 20% brings the shadow billing premium to 50%.
| Fee code | Description | Shadow billing |
|---|---|---|
| G365A | Papanicolaou Smear | 50% |
| G378A | Insertion of intrauterine contraceptive device | 50% |
| G552A | Removal of intrauterine contraceptive device | 50% |
| R048A | Malignant Lesions - Face or neck - Simple excision - single lesion | 50% |
| R051A | Laser surgery on Group 1-5 and malignant lesions | 50% |
| R094A | Malignant Lesions - Other areas - Simple excision - single lesion | 50% |
| Z101A | Incision - Skin - Abscess- Subcutaneous - Local Anaesthetic | 50% |
| Z110A | Extensive debridement of onychogryphotic nail with removal of multiple laminae | 50% |
| Z113A | Incision - Biopsy any method; when sutures are not used | 50% |
| Z114A | Incision - Foreign body removal local anaesthetic | 50% |
| Z116A | Incision - Biopsy(ies) - Any Method; When Sutures Are Used | 50% |
| Z117A | Chemical And/or Cryotherapy Treatment of Minor Skin Lesion(s) | 50% |
| Z122A | Cyst, Haemangioma, Lipoma - Face or Neck - Local Anaesthetic - Single Lesion | 50% |
| Z125A | Cyst, Haemangioma, Lipoma - Other Areas - Local Anaesthetic - Single Lesion | 50% |
| Z128A | Simple, Partial or Complete, Nail Plate Excision Requiring Anaesthesia | 50% |
| Z129A | Simple, Partial or Complete, Nail Plate Excision Requiring Anaesthesia - Multiple | 50% |
| Z154A | Suture Of Lacerations - Up To 5cm - If on Face And/or Requires Tying of Bleeders And/or Closure in Layers | 50% |
| Z156A | Group 1 - Verruca, Keratosis, Pyogenic Granuloma - Removal by Excision and Suture - Single Lesion | 50% |
| Z157A | Group 1 - Verruca, Keratosis, Pyogenic Granuloma - Removal by Excision and Suture - Two Lesions | 50% |
| Z158A | Group 1 - Verruca, Keratosis, Pyogenic Granuloma - Removal by Excision and Suture - Three Or More Lesions | 50% |
| Z159A | Group 1 - Verruca, Keratosis, Pyogenic Granuloma - Removal by Electrocoagulation And/or Curetting - Single Lesion | 50% |
| Z160A | Group 1 - Verruca, Keratosis, Pyogenic Granuloma - Removal by Electrocoagulation And/or Curetting - Two Lesions | 50% |
| Z161A | Group 1 - Verruca, Keratosis, Pyogenic Granuloma - Removal by Electrocoagulation And/or Curetting - Three Or More Lesions | 50% |
| Z162A | Group 2 - Nevus - Removal by Excision and Suture - Single Lesion | 50% |
| Z175A | Skin - Suture - Laceration - 5.1 to 10cm | 50% |
| Z176A | Skin - Suture - Laceration - Up to 5cm | 50% |
| Z314A | Treatment Of Epistaxis - Cauterization - Unilateral | 50% |
| Z315A | Treatment Of Epistaxis - Anterior Packing - Unilateral | 50% |
| Z535A | Endoscopy - Sigmoidoscopy with or Without Anoscopy - With Rigid Scope | 50% |
| Z543A | Endoscopy - Anoscopy (Proctoscopy) | 50% |
| Z545A | Incision - Thrombosed Haemorrhoid(s) | 50% |
| Z847A | Incision - Removal of One Embedded Foreign Body - Local Anaesthetic | 50% |
| E542A | When performed outside hospital | 50% |
| G462A | Administration of Oral Polio Vaccine | 50% |
| G538A | Immunization - Each Injection not otherwise listed | 50% |
| G840A | Immunization - Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio Virus (DTaP-IPV) paediatric | 50% |
| G841A | Immunization - Diphtheria, Tetanus, acellular Pertussis, Inactivated Polio Virus, Haemophilus influenza type b (DTaP-IPV-Hib) paediatric | 50% |
| G842A | Immunization - Hepatitis B (HB) | 50% |
| G843A | Immunization - Human Papillomavirus (HPV) | 50% |
| G844A | Immunization - Meningococcal C Conjugate (Men-C) | 50% |
| G845A | Immunization - Measles, Mumps, Rubella (MMR) | 50% |
| G846A | Immunization - Pneumococcal Conjugate (Pneu) | 50% |
| G847A | Immunization - Tetanus, Diphtheria, acellular Pertussis (Tdap) | 50% |
| G848A | Immunization - Varicella (VAR) | 50% |
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