Billing code
Q043A — New Patient Fee FIT Positive or increased colorectal risk
New patient after abnormal FIT
Bill Q043A once when you enrol a new patient referred for an abnormal FIT or increased colorectal cancer risk; the amount depends on age.
Watch for: Complete and keep the signed enrolment and New Patient Declaration forms, and use their date as the service date.
| Provider | Specialist | Assistant | Anaesthetist | Non-anaesthetist |
|---|---|---|---|---|
| $150.00 | $0.00 | $0.00 | $0.00 | $0.00 |
- Code
- Q043A
- Description
- New Patient Fee FIT Positive or increased colorectal risk
- FHO+ basket
- Not in the FHO+ base rate basket (Schedule 2 or 2B).
- Effective date
- Apr 1, 2025
- Termination date
- No end date
Explanation
Updated October 26, 2026
New patient fee for enrolling a patient referred for follow-up of an abnormal FIT or increased colorectal cancer risk. The amount depends on age.
What it covers
Q043A is the new patient fee for enrolling a patient with an abnormal colorectal cancer screen or at increased risk of colorectal cancer (AQ1). In the 2020 OMA guide, the ColonCancerCheck program keeps a list of physicians accepting such patients and contacts a listed physician when a patient without a family physician has an abnormal FIT, to arrange follow-up such as referral for colonoscopy (OMA Q-codes guide p.11). The April 2026 FHO agreement describes a new patient referred by Ontario Health for follow-up of a positive FIT (Agreement p.70 §10.2).
The payment is set by the patient's age: up to 64, 65 to 74, and 75 or older (AQ1). Appendix Q is information only and points to INFOBulletin 4723 for the minimum requirements to claim Q043A (AQ1).
Billing rules
- The physician and patient complete and sign the Patient Enrolment and Consent to Release Personal Health Information (E/C) form and a New Patient Declaration form. The patient gets a copy of the E/C form; the physician keeps both (OMA Q-codes guide p.11).
- FHO: the patient must be enrolled to the FHO physician billing Q043A, and the New Patient Declaration Form (Appendix B.1) must be kept on file (Agreement p.70–71 §10.2).
- The service date must be the date on the E/C form and the New Patient Declaration form (OMA Q-codes guide p.11).
- No annual limit on the number of Q043A claims (OMA Q-codes guide p.11).
- If your billing software can't bill different amounts for one code, bill the youngest age band's amount and the Ministry adjusts it by age (OMA Q-codes guide p.11).
- Eligible models: CCM, FHG, FHN, FHO, RNPGA, BSM, GHC, SJHC, SEAMO and WHA (AQ1).
Often billed with
- Q200A rostering code for the same patient; both are dated on the E/C form (OMA Q-codes guide p.10–11).
Related codes: Q200, Q023, Q053, Q150, Q152
Source: Schedule of Benefits (July 1, 2026), Appendix Q (information only), New Patient Fees, page AQ1; OMA Q-codes guide p.11; FHO agreement p.70–71 §10.2
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