New patient attachment bonus

The new patient attachment bonus only applies to patients without a family doctor (unattached patients) who are new to you and your group.

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 the patient attachment bonus is completion of the New Patient Delcaration Form by you and the patient.

The 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 them (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.

For you to be eligible to claim an unattached patient fee for a patient, the patient must be new to you and your group. The New Patient Declaration Form and the Unattached Patient Declaration Form asks the patient to declare they do not have a family physician because:  

The patient’s family physician has moved to another community;
The patient has moved to another community;
The patient’s family physician is no longer available due to illness, death or retirement;
The patient’s family physician is no longer available due to change of practice; or,
Up until now, the patient has not had or felt they needed a family physician

If a patient informs you that they (or the person they’re responsible for) fall under one of the following circumstances, then they are not considered to be unattached and an unattached patient fee code will not be available for them:

The patient is currently or was previously enrolled to you or another physician in your group
The patient was transferred within the same group or transferred with you to a new group
The patient is a newborn whose mother is enrolled to you
The patient already has a family physician in their community (including a fee-for-service family physician)

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 a patient attachment bonus or one of the other new patient fees.

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, 8:00 a.m. to 5:00 p.m. ET).

The value of the new patient attachment bonus

The value of the patient attachment bonus payment is based on:

Whether you are a new graduate,
The age of the patient, and
Your Rurality Index for Ontario (RIO) score or your group's RIO score, whatever is higher

There are two fee codes for the patient attachment bonus: one for established doctors (Q027A) and one for new graduates (Q037A).

Existing doctor in a patient enrolment model: fee code Q027A

Newly enroled patient	RIO < 40	RIO = or > 40
Age 0-64	$100	$150
Age 65+	$120	$180

New graduate in a patient enrolment model: fee code Q037A

Newly enroled patient	RIO < 40	RIO = or > 40
Age 0-64	$150	$225
Age 65+	$180	$270

New graduates are defined as:

Physicians who join a PEM within three years of completing a family medicine residency
Physicians who are International Medicine Graduates, have completed family medicine postgraduate training and have received an independent practice license within three years of joining a PEM

New graduate eligibility begins when you join the PEM and continues for 12 months.

The new patient attachment bonus fee codes will end Mar. 31, 2028.

Required documentation

For all patients, have the patient sign and date both the New Patient Declaration and the Enrolment and Consent (E/C) forms, ideally on their first visit. Forms may be signed electronically.

The patient is given a copy of the E/C form, and you must retain a copy of both forms for your records. The completed forms must be made available to the Ministry for audit purposes upon request.

For retroactively enroled patients (July 1, 2025 to Oct. 31, 2026) who have not yet signed a New Patient Declaration form, you will have 12 months (until Oct. 31, 2027) to get this done.

How to bill for the patient attachment bonus

The new patient attachment bonus codes are available for billing as of Nov. 1, 2026.

When submitting a patient attachment bonus fee code, bill the lowest value associated with the code. For each fee code, the ministry will adjust the payment value based on the RIO score of the physician or practice (whichever is higher) and the patient’s age at the time of service.

For example, you are an established physician, and you attach an eligible 55-year-old patient. You should bill the Q027A with a value of $100. If your practice’s RIO score is >40, the ministry will automatically adjust and pay the higher fee value of $150.

Provided that all billing requirements are met, payments will be made retroactively to July 1, 2025.

Patient must meet the definition of a “new patient” (refer to criteria)
Patient’s first visit must be on or after July 1, 2025, and in the usual family medicine clinical practice setting
Patient is enrolled to the group using the appropriate enrolment code (e.g., Q200)
Prospectively enrolled patients must complete both the Primary Care New Patient Declaration form and the Patient Enrolment and Consent to Release Personal Health Information form.
- Copies of the completed forms must be kept in the patient’s chart for audit purposes. They do not need to be submitted to the ministry. Electronic copies in the chart are sufficient; paper copies do not need to be kept.
- For patients who were enrolled from July 1, 2025 to the time when the codes are available to bill, the ministry is still deciding how long you will have to get them to sign the Primary Care New Patient Declaration form.
Once the patient attachment bonus fee codes are available, they may need to be billed with the first visit on or after enrolment for all new enrolments.
- For retroactively enrolled patients and patients enrolled prospectively up until the point the fee codes are announced, you may need to back-date the service date for the patient attachment bonus to the first billable service in the usual family practice setting, either on or after the date of enrolment. For these patients, you will have six months to claim the patient attachment bonus once the new codes are implemented.
Only one attachment code per patient can be billed; if two are submitted (e.g., the new attachment codes and an HCC attachment code) the ministry will pay the higher of the two.

The patient attachment bonus may only be billed once by the same group enrolling the same patient
The following claims will be rejected and paid at $0:
- Attachment bonus billed prior to enrolment
- Attachment bonus submitted with an emergency room or in-patient identifier; this is because the emergency room is outside the usual family medicine clinical practice setting
The attachment bonus paid to the group will be recovered if:
- a group chooses to de-roster a new patient within 12 months of formal enrolment, using “Q402 de-roster - ended by provider”, or
- a Batch Roster End is applied within 12 months of formal enrolment
The patient attachment bonus cannot be billed in addition to the Health Care Connect attachment bonus, mother newborn new patient bonus or multiple/newborn bonus. If two are billed, the ministry will pay the higher fee.

What you should do now

Continue to bill the appropriate enrolment code (e.g., Q200A) for all new enrolments. This will let the ministry know which of your patients the patient attachment bonus will apply to.

For prospectively enrolled patients:

Have them sign and date both the New Patient Declaration and Enrolment and Consent forms on their first visit.

For retroactively enrolled patients (back to July 1, 2025):

Stand by for instructions from the ministry.

For all eligible patients, once the patient attachment bonus fee codes become available, you will be able to claim them retroactively. You will need to back-date the service date for the patient attachment bonus to the first billable service in the usual family practice setting, either on or after the date of enrolment.

Related resources

Ministry INFOBulletin

Unattached patient fees

Specialized unattached patient fees

FAQs about unattached patient fees

Patient forms

Patients may sign the form at home and send to you digitally via a secure format, such as Ocean. Once completed, both forms must be kept on file for audit purposes.

Patient Enrolment and Consent to Release Personal Health Information

Primary Care New Patient Declaration form

The new patient attachment bonus

Eligibility

When is a patient considered unattached?

When is an unattached patient fee not available?