Ontario preventive care bonus 2026: targets, codes and who's eligible
The preventive care bonus is a once-a-year payment for primary care physicians in patient enrolment models. You earn it when a high enough share of your enrolled patients have had certain preventive services.
- 5 bonus categories
- 2 of 5 claimable by FHO and FHN
- $4,000 top colorectal tier
- March 31 service date on every claim
Who is eligible
| Model | Categories you can claim | Roster rule |
|---|---|---|
| FHO, FHN | Influenza and childhood immunizations only | No minimum; prorated under 1,000 enrolled patients |
| FHG, CCM | All five | At least 650 enrolled patients on March 31 (450 for new graduates in their first year in an FHG or CCM) |
| RNPGA, BSM, GHC, SJHC, WAHA | All five | No minimum roster |
You must be a signatory physician active with an eligible enrolment model on March 31 of the fiscal year (INFOBulletin 260805). Rules from (INFOBulletin 240503), (INFOBulletin 260805) and (Schedule of Benefits, Appendix Q, pages AQ5 to AQ11).
Eligible models, roster counts and the FHO/FHN change
The Ministry lists CCM, FHG, FHN, FHO, BSM, GHC, SJHC, WAHA, RNPGA and GP Focus HIV as eligible models (INFOBulletin 260805).
FHG and CCM physicians can find their roster count in the monthly Roster Capitation Reconciliation Report sent through MCEDT (INFOBulletin 260401).
FHO and FHN physicians lost the cervical, mammography and colorectal bonuses for fiscal 2024–25 (April 1, 2024 to March 31, 2025) onward. Claims for those codes reject with EPA, "Network Billing Not Approved" (INFOBulletin 240503).
The FHO+ agreement lists only the influenza and childhood immunization bonuses for FHO physicians (FHO agreement Appendix I §8.1, p.65–66).
FHO and FHN reports still show all five categories. The three ineligible ones are marked as for reporting only (INFOBulletin 240503).
Proration for FHO and FHN rosters under 1,000
| Example | Value |
|---|---|
| Enrolled patients on March 31 | 575 |
| Tier reached | 75% influenza (Q103A, $1,100) |
| Bonus paid | 575 ÷ 1,000 × $1,100 = $632.50 |
This applies to the influenza and childhood immunization bonuses. With 1,000 or more enrolled patients, they are paid in full (INFOBulletin 240503).
The five categories at a glance
| Category | Tier codes | Bonus range | FHO/FHN can claim |
|---|---|---|---|
| Influenza | Q100A–Q104A | $220 to $2,200 | Yes |
| Cervical cancer screening | Q105A–Q109A | $220 to $2,200 | No |
| Mammography | Q110A–Q114A | $220 to $2,200 | No |
| Childhood immunizations | Q115A–Q117A | $440 to $2,200 | Yes |
| Colorectal cancer screening | Q118A–Q123A | $220 to $4,000 | No |
Each tier code is billed at $0.00 and OHIP pays the bonus for that tier (Schedule of Benefits, Appendix Q, pages AQ5 to AQ11). Ages are as of the date shown, in the fiscal year (April 1 to March 31).
Influenza
| Influenza | Detail |
|---|---|
| Target population | Enrolled patients aged 65 or older on December 31 of the fiscal year |
| Covered if | Vaccinated for that flu season by January 31 |
| 60% coverage | Q100A · $220 |
| 65% coverage | Q101A · $440 |
| 70% coverage | Q102A · $770 |
| 75% coverage | Q103A · $1,100 |
| 80% coverage | Q104A · $2,200 |
| Other codes counted | G590A, Q690A, Q691A |
| Tracking code | Q130A: the patient got the flu vaccine elsewhere |
| Exclusion code | None |
| FHO/FHN | Can claim |
Cervical cancer screening
| Cervical cancer screening | Detail |
|---|---|
| Target population | Patients with a cervix aged 25 to 69 on March 31 (sexually active patients only) |
| Covered if | Screened in the 66 months before March 31 |
| 60% coverage | Q105A · $220 |
| 65% coverage | Q106A · $440 |
| 70% coverage | Q107A · $660 |
| 75% coverage | Q108A · $1,320 |
| 80% coverage | Q109A · $2,200 |
| Other codes counted | G365A, L734A, L699A, E430A, E431A, Q678A; HPV screen L698 from the April 2026 reports |
| Tracking code | Q011A: the patient was screened elsewhere |
| Exclusion code | Q140A: hysterectomy, cervical disease that precludes regular screening, or not sexually active |
| FHO/FHN | Cannot claim |
Cervical screening code changes
The Ministry added the HPV screen (L698) to the services it reports, starting with the April 2026 reports (INFOBulletin 260301) (INFOBulletin 260302).
Lab codes L713A and L733A no longer count for services from April 2025 onward, but earlier ones within the 66 months still do (INFOBulletin 260805).
Remove patients who are not sexually active from the cervical screening count (Ministry procedures document, section 6.1).
Mammography
| Mammography | Detail |
|---|---|
| Target population | Female, trans and non-binary patients aged 50 to 74 on March 31 |
| Covered if | Mammogram in the 30 months before March 31 |
| 55% coverage | Q110A · $220 |
| 60% coverage | Q111A · $440 |
| 65% coverage | Q112A · $770 |
| 70% coverage | Q113A · $1,320 |
| 75% coverage | Q114A · $2,200 |
| Other codes counted | X178A, X178B, X178C, X185A, X185B, X185C |
| Tracking code | Q131A: the patient had a mammogram elsewhere |
| Exclusion code | Q141A: mastectomy, or being treated for clinical breast disease |
| FHO/FHN | Cannot claim |
Childhood immunizations
| Childhood immunizations | Detail |
|---|---|
| Target population | Enrolled children aged 30 to 42 months on March 31 |
| Covered if | All Ministry-supplied immunizations recommended by NACI, given by 30 months of age |
| 85% coverage | Q115A · $440 |
| 90% coverage | Q116A · $1,100 |
| 95% coverage | Q117A · $2,200 |
| Other codes counted | G538A, Q688A, Q689A, G840A, G841A, G844A, G845A, G846A, G848A |
| Tracking code | Q132A: the child's immunizations are complete |
| Exclusion code | None |
| FHO/FHN | Can claim |
Colorectal cancer screening
| Colorectal cancer screening | Detail |
|---|---|
| Target population | Enrolled patients aged 45 to 74 on March 31 (50 to 74 before September 2026) |
| Covered if | FOBT or FIT in the 30 months before March 31 |
| 15% coverage | Q118A · $220 |
| 20% coverage | Q119A · $440 |
| 40% coverage | Q120A · $1,100 |
| 50% coverage | Q121A · $2,200 |
| 60% coverage | Q122A · $3,300 |
| 70% coverage | Q123A · $4,000 |
| Other codes counted | L179A, Q700A |
| Tracking code | Q133A: the patient was screened elsewhere |
| Exclusion code | Q142A: known cancer followed by a physician, inflammatory bowel disease, colonoscopy in the last 10 years, history of malignant bowel disease, or a disease needing surveillance colonoscopies |
| FHO/FHN | Cannot claim |
Colorectal age range change
The colorectal age range changed when Ontario lowered the start age for average-risk screening to 45. The September 2026 reports use 45 to 74 (INFOBulletin 260702).
Where these tables come from
Target populations and coverage rules: (INFOBulletin 260805) and the Ministry of Health's Information and Procedures for Claiming the Cumulative Preventive Care Bonus, revised March 2025, pages 3–4.
Tier codes and amounts: (Schedule of Benefits, Appendix Q, pages AQ5 to AQ11), the Ministry procedures document, section 6.2, and (INFOBulletin 240503).
Other codes counted: Ministry procedures document, page 6. The Q6xx and Q700A codes are nurse practitioner codes.
Tracking and exclusion codes: (INFOBulletin 260805) and the Ministry procedures document, page 7. There is no exclusion code for influenza or childhood immunizations.
Billing details: the code pages for Q100A and Q115A.
Working out your coverage level
- Start with the patients listed for the category on your Target Population/Service Report.
- Subtract the patients who meet the exclusion criteria.
- Count the remaining patients who had the service, using the report and your own records.
- Divide covered patients by the remaining patients and multiply by 100.
- Round to two significant digits and find the highest tier you reached.
Formula: covered patients ÷ (patients on the report − excluded patients) × 100 (Ministry procedures document, section 6.1). Try your own numbers in the preventive care bonus calculator.
Worked example: colorectal screening
A report lists 321 patients for colorectal screening. Thirteen meet the exclusion criteria, which leaves 308.
If 92 of them had an FOBT or FIT in the 30 months before March 31, coverage is 92 ÷ 308 × 100 = 29.87%, which rounds to 30%.
That reaches the 20% tier, so the physician claims Q119A for $440 (Ministry procedures document, sections 6.1–6.2). This example applies only to models still eligible for the colorectal bonus.
Billing tracking and exclusion codes
Tracking codes record that a patient got the service elsewhere, such as a flu shot at a workplace clinic. Exclusion codes remove a patient from the target population (INFOBulletin 260805).
- Bill them like any other claim, at $0. They are voluntary.
- The RA pays $0 with explanatory code 30, "This service is not a benefit of OHIP" (Ministry procedures document, pages 7–8).
- Reports show tracking codes from any physician in your group, and exclusion codes from the enrolling physician (INFOBulletin 260805).
- They stay on the reports for 30 months, or 66 months for cervical screening.
- An influenza tracking code shows only on the next April's Previous Report (Ministry procedures document, page 8).
Your Target Population/Service Reports
| Report | When | Use |
|---|---|---|
| Previous Report | April | The year just ended; use it to claim |
| Projected Report | April, and again in September | The new fiscal year |
TPSRs go to your solo billing number through MCEDT. If it is not registered for MCEDT, register it to get them (INFOBulletin 260805).
Why a patient can appear without a service
Report timing comes from the Ministry procedures document, page 5, and (INFOBulletin 260805).
Projected Reports do not show influenza services, because the flu vaccine is given later in the season (INFOBulletin 260805).
A patient can appear without a service if the claim was not processed yet, the service was not billed to OHIP, or the patient has not consented to release of information (Ministry procedures document, page 6).
How and when to claim
Claim after the fiscal year ends, once the Ministry sends the Previous Report and instructions. For 2025–26, the Ministry asked physicians to start claiming on March 31, 2026 (INFOBulletin 260401).
- Use the billing number you used for your enrolment model services on March 31 of the fiscal year.
- Use March 31 of the fiscal year as the service date.
- Leave the health number, version code and birth date blank. If your billing software cannot do this, ask your vendor.
- Bill the tier code at $0.00, one code per category.
- Note each preventive service in the patient's chart. You do not send documentation with the claim, but the Ministry can audit.
- Submit before the Ministry's claims cut-off in June.
Cut-off dates, payment and sources
For the 2024–25 bonus, the Ministry gave June 10 for paper claims and June 18 for MCEDT (Ministry procedures document, revised March 2025, section 6.4).
The payment shows on your RA under "Preventive Care Bonus Accumulations and Payment". In an FHO, FHN or other group model, the group total also appears on the Group Total Summary Report (Ministry procedures document, page 8).
Claim steps come from the Ministry procedures document, sections 6.3–6.5, (INFOBulletin 260401) and (Schedule of Benefits, Appendix Q, pages AQ5 to AQ11).
For how the bonus fits with the rest of FHO+ pay, see the FHO+ billing guide.
Sources
OHIP INFOBulletin 240503: Changes to the Preventive Care Bonus for FHN/FHO physicians
OHIP INFOBulletin 260401: 2025–2026 Preventive Care Bonus Information
OHIP INFOBulletin 260805: Preventive Care Bonus Projected Reports – September 2026
OHIP INFOBulletin 260301: Preventive Care – Cervical Screening Service Added
OHIP INFOBulletin 260302: Preventive Care – Cervical Screening Service Added – FHN/FHO
OHIP INFOBulletin 260702: Changes to colonoscopy and colorectal cancer screening
Schedule of Benefits: Physician Services, effective July 1, 2026 (Appendix Q)
OMA: FHO+ agreements and forms (FHO Physician Payment Agreement 2026-04)
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