Unattached patient fees

Unattached patient fees, including the new patient attachment bonus, provide financial incentives for family physicians to enrol unattached patients. Several new unattached patient fees were introduced with the 2024-28 Physician Services Agreement.

In addition to the new unattached patient fees, the existing one-time fees available for enrolling eligible patients who had recent hospital stays (Q023) or who are at increased risk of colorectal cancer (Q043) are still in effect. Note that only one unattached patient fee may be billed per patient.

What’s new

A new one-time fee is available for each new unattached patient enrolled (i.e., previously unattached to a family physician). The fee is known as the patient attachment bonus and it is available to family physicians in all patient enrolment models (PEMs), excluding locums.

In addition, there are now separate one-time fees available for attaching: 

• Health Care Connect patients who are ‘complex/vulnerable’   
• Select mother and newborn bonuses

The new fees apply to new patients without a family doctor who are enrolled from July 1, 2025, onwards and who have signed a New Patient Declaration and an Enrolment and Consent form.

Only one unattached patient fee may be billed per patient. The billing codes for these new unattached patient fees are available to claim as of Nov. 1, 2026.   

The existing Health Care Connect complex and/or vulnerable unattached new patient fee (Q053) has been sunset as of Oct. 31, 2026. You can continue to bill this code for eligible patients enrolled up to Oct. 31. Claims for Q053 for patients enrolled after Oct. 31 will be rejected. For new patients from the HCC list that are complex/vulnerable (identified by HCC or by you) and enrolled from Nov. 1, 2026 onwards, use the new code, Q058. 

Summary of unattached patient fees

The following table reflects all existing and new unattached patient fees. New codes are in effect as of Nov. 1, 2026.

Only one unattached patient fee can be claimed per patient. If two unattached patient fee codes are billed, the ministry will pay the first one processed. The only exception to this is the mother/newborn and multiple newborn fee codes, which can be billed together when applicable.

Eligibility

Only family physicians who are members of a Patient Enrolment Model (PEM) are eligible to bill the unattached patient fee codes, including the patient attachment bonus. Locums working in a PEM are not eligible to bill these codes.

The general eligibility requirement for all unattached patient fees is completion of a declaration form by you and the patient. Most unattached patient fees are associated with completion of the Primary Health Care New Patient Declaration Form. PEM physicians must use the Unattached Patient Declaration Form when billing the code for enrolling an unattached patient from hospital fee (Q023).

Each form requires the physician to attest that:  

• The patient is new to you, AND
• To the best of your knowledge, the patient is new to your group

The patient should also confirm they do not have a family physician and declare which circumstance listed on the form applies to their circumstance (see below). You may rely on what they tell you for purposes of the declaration form. It’s always best practice to document what the patient told you and note that the forms that were completed, including the New Patient Declaration Form or the Unattached Patient Declaration Form.

Note that in addition to the requirements above, each of the specialized unattached patient fees (e.g., HCC complex/vulnerable; unattached mother and newborn, etc.) have other specific eligibility requirements.

Note that to receive any of the unattached patient fees, including the patient attachment bonus, all eligibility criteria must be met. Completion of the New Patient Declaration Form does not, on its own, entitle you to receive an unattached patient fee.  

If you have questions about a specific patient scenario, you may reach out to the Ministry of Health Service Support Contact Centre (SSCC) for clarification by email (SSContactCentre.MOH@ontario.ca) or phone 1-800-262-6524 (Monday to Friday, 8 a.m. to 5 p.m. ET).