FHO+ billing guide 2026: hourly codes, capitation, shadow billing and continuity of care
FHO+ is the updated Family Health Organization (FHO) payment model, in effect since April 1, 2026 under the 2024 Physician Services Agreement (INFOBulletin 260308). This guide explains each part of FHO+ pay and what to check each month.
- 30% shadow billing premium
- 50% Q012A after-hours premium
- $80 an hour, most hourly codes
- 75% continuity of care target
About the agreement references
The 2024 Physician Services Agreement is between the Ministry of Health and the OMA.
Capitation is still the base. FHO+ adds hourly payments, raises the shadow billing and after-hours premiums, and replaces the access bonus with a continuity of care measure.
Section and page references (for example §6.6, p.63) are to Appendix I, Payment Terms, of the 2026-04 FHO Physician Payment Agreement. The OMA posts the agreement on its FHO+ agreements and forms page.
What changed on April 1, 2026
| Item | Before April 1, 2026 | From April 1, 2026 | Source |
|---|---|---|---|
| Shadow billing premium | 19.41% | 30% of the fee | Agreement §4.3 p.59; INFOBulletin 260308 |
| Schedule 2B procedures (44) | Same as other in-basket codes | Another 20%, 50% in total (paid from May 2026, back to April 1) | Agreement §4.4 p.59; INFOBulletin 260502 |
| After-hours premium (Q012A) | 30% | 50% of the full fee | Agreement §8.12 p.68; INFOBulletin 260308 |
| Hourly payments | Not part of FHO pay | Q310A to Q313A, $80 or $68 an hour | Agreement §6.1 p.61–62; INFOBulletin 260309 |
| Access bonus | In place | Ended | INFOBulletin 260308 |
| Outside use deductions | In place | Ended; Outside Use Report still sent for reference | INFOBulletin 260308 |
| Comprehensive care capitation | In place | Ended | INFOBulletin 260308 |
| Continuity of care | Not in place | 75% measure; below it can cut the base rate | Agreement §5 p.60–61 |
| FHO core (in-basket) list | Earlier list | E089A, G849A, K125A added | INFOBulletin 260316 |
| Long-term care core list | Earlier list | E432A, W124A added | INFOBulletin 260316 |
| Q012A eligible codes | Earlier list | E089A added | INFOBulletin 260316 |
Access bonus, outside use deductions and comprehensive care capitation ended for FHO physicians on April 1, 2026 (INFOBulletin 260308).
FHO+ payments at a glance
| Payment | What it pays for | Amount or rate | Source |
|---|---|---|---|
| Base rate capitation | Each enrolled patient, per day | Annual rate by age and sex, from $62.63 to $557.61 | Agreement §4.1 p.59; Schedule 1 p.74 |
| Complexity-based capitation | Each enrolled patient, adjusted for health complexity | Not stated in the agreement's payment terms | Agreement §4.2 p.59 |
| Long-term care base rate | Each enrolled patient living in long-term care | $1,223.22 a year (not age or sex adjusted) | Agreement §4.5 p.59 |
| Shadow billing premium | In-basket services to enrolled patients | 30% of the fee | Agreement §4.3 p.59; INFOBulletin 260308 |
| Extra shadow billing premium | 44 listed in-basket procedures (Schedule 2B) | Another 20%, for 50% in total | Agreement §4.4 p.59; INFOBulletin 260502 |
| Hourly payments | Q310A, Q312A, Q313A time | $80 an hour ($20 per 15-minute unit) | Agreement §6.1 p.61–62; INFOBulletin 260309 |
| Hourly payments | Q311A phone time when not in the office | $68 an hour ($17 per 15-minute unit) | Agreement §6.1 p.61; INFOBulletin 260309 |
| After-hours premium (Q012A) | Listed visit codes for enrolled patients in evening, weekend and holiday hours | 50% of the full fee | Agreement §8.12 p.68; INFOBulletin 260308 |
| Fee-for-service | Out-of-basket services to enrolled patients | 100% of the fee | Agreement §7.1 p.64 |
| Fee-for-service | Services to non-enrolled patients | 100% of the fee; in-basket services capped per group each year | Agreement §7.3 p.64 |
| Continuity of care | Not a payment: an accountability measure | Below 75% can cut the base rate by 15% of one quarter's base rate | Agreement §5 p.60–61 |
Capitation: the base rate
- $62.63 lowest annual rate, males 10–14
- $557.61 highest, females 90 and older
- $1,223.22 long-term care, per year
| Capitation part | How it is paid | Source |
|---|---|---|
| Base rate | Each day a patient is enrolled: the annual rate for the patient's age and sex band in Schedule 1, prorated | Agreement §4.1 p.59 |
| Seniors' care premium | 15%, built into the base rate for patients aged 65 and older | Agreement §4.1 p.59 |
| Complexity-based capitation | Added for each enrolled patient: an acuity-modified base rate based on calculated health complexity. Amounts not given in the payment terms | Agreement §4.2 p.59 |
| Long-term care base rate | Flat $1,223.22 a year for enrolled patients living in a long-term care home, not by age or sex | Agreement §4.5 p.59 |
Capitation is paid only for days a patient is enrolled, so enrol new patients promptly with Q200A.
Annual rates run from $62.63 (males aged 10 to 14) to $557.61 (females aged 90 and older) (Schedule 1, p.74). Full table: FHO+ capitation rates by age and sex.
Complexity-based capitation and long-term care details
Part of the complexity-based capitation funding came from the preventive care bonus categories that FHO and FHN physicians lost in 2024 (INFOBulletin 240503).
The long-term care rate depends on extra service obligations, including a medication review every three months and an average of two assessments per patient per month (Agreement §4.7, p.60).
The codes are in FHO+ long-term care fee codes.
Shadow billing: the blended fee-for-service premium
| In-basket service to an enrolled patient | Premium OHIP pays | Source |
|---|---|---|
| Schedule 2 (community) and Schedule 2A (long-term care) codes | 30% of the fee (19.41% before April 1, 2026) | Agreement §4.3 p.59; INFOBulletin 260308 |
| 44 procedures in Schedule 2B, such as Pap smears (G365A), IUD insertion and removal (G378A, G552A), skin excisions and immunizations (G840A to G848A) | Another 20%, 50% in total | Agreement §4.4 p.59; INFOBulletin 260502 |
You still submit a claim for every in-basket (core) service. The base rate covers the rest of the fee (Agreement §4.3, p.59).
In-basket code lists and the April 2026 additions
In-basket services are the codes in Schedule 2 (community) and Schedule 2A (long-term care) of the agreement. INFOBulletin 260316 added E089A, G849A and K125A to the FHO core list, and E432A and W124A to the long-term care core list, from April 1, 2026.
The full lists are in FHO+ in-basket codes.
The 30% premium rose from 19.41% on April 1, 2026 (INFOBulletin 260308). Forty-four procedures in Schedule 2B get another 20%. The Ministry started paying the extra 20% in May 2026, back to April 1, 2026 (INFOBulletin 260502).
Hourly payments: Q310A to Q313A
FHO+ pays FHO physicians and FHO contracted physicians by the hour for work for enrolled patients in the usual family practice setting, including long-term care homes and home visits (Agreement §6.1, p.61).
| Code | What it covers | Rate | Per 15-minute unit |
|---|---|---|---|
| Q310A | Direct care in person or by synchronous virtual care, including phone care from the office and teaching during care | $80 an hour | $20 |
| Q311A | Phone care to enrolled patients when you are not in your usual clinic setting | $68 an hour | $17 |
| Q312A | Indirect care for a specific enrolled patient: charting, reviewing results, referrals, care coordination, talking with family or other providers, clinically required forms | $80 an hour | $20 |
| Q313A | Clinical administration for your roster: screening and disease management outreach, EMR work that needs a physician, quality improvement | $80 an hour | $20 |
Sources: Agreement §6.1, p.61–62; INFOBulletin 260309.
| Limit | Rule | If exceeded |
|---|---|---|
| Daily | All four codes together: 14 hours (56 units) a day | Single item over 56 units rejects with A3H; time over the daily limit approved at $0 with MD |
| Monthly | 240.0 to 265.7 hours, by days in the month (table below) | Time over the limit approved at $0 with M5 |
| Indirect and admin mix | Q312A + Q313A no more than 25% of your hourly total | — |
| Admin mix | Q313A no more than 5% of your direct and indirect care hours | — |
Sources: Agreement §6.6–6.7, p.63–64; INFOBulletin 260309.
What hourly codes don't cover
- Running the clinic, such as managing staff, finance, supplies, leases or insurance, is not Q313A time; nor is work for a specific patient (Agreement §6.2, p.63).
- Third-party forms you can bill the patient for, such as insurance forms, are not Q312A time (Agreement §6.1(iii)(j), p.62).
- The emergency department, in-hospital work (admitted patients, hospitalist work, labour and delivery), anaesthesia, surgical assists and Independent Health Facilities (Agreement §6.5, p.63).
- Non-enrolled patients, uninsured services and travel time (Agreement §6.5, p.63).
How to bill hourly time
- Add up your time for each code for the day. Use the date the work was done.
- Bill it in 15-minute units. A remainder of 8 minutes or more counts as a full unit (Agreement §6.4, p.63). For example, 2 hours of direct care is 8 units of Q310A.
- Bill the dollar value that matches your units: $20 a unit for Q310A, Q312A and Q313A, and $17 for Q311A.
- Leave the health number, version code and birth date blank.
- Bill under your FHO group or solo billing number. Locums bill under the FHO group number.
Source: INFOBulletin 260309.
| RA code | What it means |
|---|---|
| V41 | Hourly claim billed at $0.00: incorrect fee billed (since May 1, 2026) |
| VHB or VH1 | Health number, version code or birth date was filled in |
| A3H | A single claim item over 56 units |
| MD | Time over the 14-hour daily limit, approved at $0 |
| M5 | Time over the monthly limit, approved at $0 |
| EPA | Billed by a physician not affiliated with an FHO |
Sources: INFOBulletin 260501 for V41; INFOBulletin 260309 for the rest.
Who cannot bill hourly codes, and the amount actually paid
Income stabilization physicians cannot bill these codes, and physicians not affiliated with an FHO get EPA (INFOBulletin 260309).
The Ministry says its 2026–27 relativity rates apply to hourly payments (INFOBulletin 260309), so check your RA for the amount actually paid.
Monthly hourly limits
| Days in the month | Monthly limit | Units |
|---|---|---|
| 28 | 240.0 hours | 960 |
| 29 | 248.6 hours | 995 |
| 30 | 257.1 hours | 1,029 |
| 31 | 265.7 hours | 1,063 |
Sources: Agreement §6.6, p.63–64; INFOBulletin 260309. Time over the monthly limit is approved at $0 with M5.
After-hours premium: Q012A at 50%
For enrolled patients seen in evening and weekend hours or on recognized holidays, FHO+ pays 50% of the full fee on listed codes. Q012A must be on each claim (Agreement §8.12, p.68).
The premium was 30% before April 1, 2026 (INFOBulletin 260308).
| Code group | Listed codes |
|---|---|
| A codes | A001A, A003A, A004A, A007A, A008A, A888A |
| E code | E089A (added April 1, 2026) |
| K codes | K005A, K013A, K017A, K030A, K033A, K130A, K131A, K132A, K133A |
| Q codes | Q050A, Q888A |
Sources: INFOBulletin 260308 for the list; INFOBulletin 260316 for E089A.
Schedule of Benefits still shows 30%, and who gets the premium
Appendix Q of the July 2026 Schedule of Benefits still prints Q012A at 30% (page AQ2). For FHO physicians, the agreement and the Ministry's FHO+ bulletin say 50%, so check the RA if a premium looks wrong.
The evening, weekend and holiday hours are defined in the main FHO agreement. Whether the premium is paid to the group or to you depends on which billing number is on the claim (Agreement §3.5, p.58–59).
Out-of-basket services, hospital patients and non-enrolled patients
| Service | Paid at | Source |
|---|---|---|
| Out-of-basket services to enrolled patients (codes not in Schedules 2 or 2A) | Full fee-for-service value | Agreement §7.1 p.64 |
| In-basket services to enrolled patients who are hospital in-patients | Full fee | Agreement §7.2 p.64 |
| Services to non-enrolled patients | Full fee; in-basket (Schedule 2) services capped per group each year | Agreement §7.3 p.64 |
The cap on in-basket services to non-enrolled patients
In-basket (Schedule 2) services to non-enrolled patients are capped each year at a multiplier times the number of FHO physicians in the group. The multiplier was $56,947 from April 1, 2023, and is indexed (Agreement §7.3, p.64).
The cap does not apply for the first 12 months after physicians switch from fee-for-service (Agreement §7.4, p.65).
Continuity of care replaces outside use
- 75% in-basket visits kept in-group
- 15% of one quarter's base rate at risk
Each FHO physician's roster should get at least 75% of its in-basket visits from you, another physician in your FHO, or an "acceptable physician" (Agreement §5.1, p.60).
- Continuity is measured each quarter.
- If one quarter falls below 75%, the Ministry tells you in the third quarter of the cycle.
- If the fourth quarter is also below 75%, the sixth quarter's base rate is cut by 15% of the first quarter's base rate, taken in two equal amounts (Agreement §5.5, p.61).
The Ministry sends each physician a monthly continuity report (Agreement §5.6, p.61). Worked timelines are in FHO+ continuity of care (CoC).
Who counts as an acceptable physician
Acceptable physicians use the 00 (family practice) specialty and are GP focused practice physicians billing in their focus area, physicians providing in-basket services in an emergency department or hospital (identified by a master hospital number), Care of the Elderly or HIV alternative payment plan signatories, or physicians billing A110A or A112A (Agreement §5.3, p.60–61).
The Outside Use Report
The access bonus and outside use deductions ended on April 1, 2026. The Ministry still sends the Outside Use Report through MCEDT for reference (INFOBulletin 260308).
Other FHO+ payments
| Payment | Detail | Source |
|---|---|---|
| Group Management and Leadership Payment (GMLP) | Always paid to the group | Agreement §11.1 p.71 |
| Enhanced GMLP (new) | $4 per enrolled patient per year, up to $100,000 per group; always paid to the group | Agreement §11.1 p.71; INFOBulletin 260308 |
| Annual special payments | Labour and delivery, hospital services, palliative care, office procedures, prenatal care, home visits, long-term care, serious mental illness; each with its own threshold | Agreement §8.3–8.11 p.66–68 |
| Rurality premium | Starts at a RIO score of 40 | Agreement §8.13 p.68 |
| Preventive care bonus | Continues for influenza and childhood immunizations only. See Ontario preventive care bonus 2026 |
Base rate, shadow billing premiums, complexity capitation, hourly payments and the preventive care bonus go either to the group or to each physician. All physicians in the FHO must agree on the choice (Agreement §3.3–3.4, p.58).
What to check each month
- Hourly time: totals by code against the 14-hour daily limit, the monthly limit and the 25% and 5% mix limits, and any MD, M5, A3H or V41 codes on the RA.
- Shadow billing: the 30% premium on in-basket claims and the separate 20% section in the Blended Fee-For-Service Premium Detail Report.
- Continuity of care: the Ministry's monthly report, especially in quarters that could lead to a reduction.
- After-hours: Q012A is on every eligible evening, weekend and holiday claim, and the RA pays 50%.
- Hospital work: in-patient claims carry the HIP service location indicator and the Master Hospital Number.
- Non-enrolled patients: in-basket billing against your group's annual cap.
- Roster: new patients enrolled with Q200A, and capitation on the RA that matches your roster.
- Annual bonuses: progress toward special payment thresholds and the preventive care target population reports.
To estimate how these parts add up for your practice, use the FHO+ calculator.
Sources
- OHIP INFOBulletin 260308: FHO+ Implementations for April 2026
- OHIP INFOBulletin 260309: FHO Hourly Rate Payments
- OHIP INFOBulletin 260316: 2024 PSA Primary Care changes for April 1, 2026
- OHIP INFOBulletin 260501: FHO hourly rate payment processing update
- OHIP INFOBulletin 260502: FHO Blended Fee-for-Service premium update
- OHIP INFOBulletin 240503: Changes to the Preventive Care Bonus for FHN/FHO physicians
- OMA: FHO+ agreements and forms (FHO Physician Payment Agreement 2026-04)
- OMA letter: family physicians working in hospitals under FHO+
- Schedule of Benefits: Physician Services, effective July 1, 2026 (Appendix Q)
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