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Billing code

Q053A — HCC Complex Vulnerable New Patient Fee

Complex Health Care Connect patient

Bill Q053A once when you enrol a new patient referred through Health Care Connect and identified as complex or vulnerable.

Watch for: The patient must be enrolled with you within three months of Health Care Connect registration, or the claim is rejected.

Code

Q053A

Description

HCC Complex Vulnerable New Patient Fee

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

One-time fee for enrolling a new patient referred through Health Care Connect and identified as complex or vulnerable.

What it covers

Q053A is the Health Care Connect (HCC) complex-vulnerable patient fee (AQ2): a one-time payment for enrolling a new patient through the HCC program whom HCC identified as complex or vulnerable (OMA Q-codes guide p.11–12). The amount is the same at any age (OMA Q-codes guide p.12).

Appendix Q is information only (AQ1). The April 2026 FHO agreement describes an HCC complex/vulnerable new patient payment at a different amount than Appendix Q, and extends it to patients HCC called non-complex whom the physician assesses as complex or vulnerable (Agreement p.69–70 §9.5).

Billing rules

• The patient must be registered with HCC as complex/vulnerable and enrolled with the physician within three months of HCC registration (OMA Q-codes guide p.12).
• FHO: the patient must be referred through the HCC waitlist, either identified as complex/vulnerable by HCC or, if HCC identified them as non-complex, assessed as complex/vulnerable in the physician's clinical opinion (Agreement p.69–70 §9.5).
• FHO: once per patient per FHO, billed at the first billable service for the enrolled patient in the usual family practice setting; the patient must be enrolled to the billing physician, and the fee is recovered if the patient is de-enrolled within 12 months of enrolment (Agreement p.68–69 §9.2).
• FHO: complete the New Patient Declaration Form (Appendix B.1) and keep it on file (Agreement p.69 §9.3; p.70 §9.5).
• Eligible models: CCM, FHG, FHN, FHO, RNPGA, BSM, GHC, SJHC, SEAMO and WHA (AQ2).

Often billed with

• A003A general assessment, or whichever service is the patient's first visit: in an FHO the fee is billed at the first billable in-clinic service for the enrolled patient (Agreement p.69 §9.2).
• Q200A rostering code to enrol the patient with the physician (OMA Q-codes guide p.9–10).

Common rejections

• HCC: OHIP's description is 'Health Care Connect (HCC) requirements not met'. The patient must have been registered with HCC as complex/vulnerable and enrolled within three months of that registration (OMA Q-codes guide p.12); check the patient's HCC referral and enrolment date before resubmitting.
• VH8: The date of birth on the claim doesn't match OHIP's record for that health number; correct it and resubmit.
• EPA: Q053A is limited to the models listed in Appendix Q (AQ2); EPA means OHIP doesn't show the physician approved to bill it under the billing number and group used on the claim.

Related codes: Q200, Q023, Q043, A003

Source: Schedule of Benefits (July 1, 2026), Appendix Q (information only), New Patient Fees, page AQ2; OMA Q-codes guide p.11–12; FHO agreement p.68–70 §9.2–9.5

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