Specialized unattached patient fees

Only physicians who are members of a Patient Enrolment Model (PEM) can bill these fees. A locum working with a PEM is not eligible.

Unattached patient fees (including the patient attachment bonus) may only be paid once per patient per group. If more than one unattached patient fee is billed, the ministry will pay the first one processed.

In addition to the new patient attachment bonus, new unattached patient fees will be available for:

• Health Care Connect complex patients determined to be complex by either the physician or HCC
• Select mothers and newborns

Note: The new fee codes are available to claim as of Nov. 1, 2026. The pre-existing Health Care Connect Complex bonus code (Q053) for patients determined to be complex/vulnerable by HCC will be replaced with the new code (Q058A) as of Nov. 1, 2026. Claims for Q053 after Oct. 31, 2026 will be rejected.

Existing additional unattached patient fees are available for:

• Patients with a recent acute care in-patient hospital stay
• Patients with an abnormal FIT result or identified as being at increased risk of colon cancer
• Patients enrolled through Health Care Connect and identified as complex/vulnerable by Health Care Connect

Health Care Connect complex patients

A new (higher) fee will apply for attaching select patients from the Health Care Connect list who enrolled on or after July 1, 2025: the HCC Complex/Vulnerable Unattached New Patient Fee.

As of Nov. 1, 2026, there is a new single fee code (HCC Complex/Vulnerable Unattached New Patient Fee - Q058A) for attaching these patients. When this code is billed, PEM physicians will receive a one-time payment of $500. Q058A replaces Q053 ($350).

Eligibility

Enrolling select patients from the Health Care Connect list, including:

• Patients identified by Health Care Connect as complex and/or vulnerable
• Patients from the Health Care Connect list who you later determine are complex and/or vulnerable. This means that in your clinical opinion they are complex and/or vulnerable

Note that the following patients do not qualify for the new HCC fee above; however they may be eligible for new patient attachment bonus:

• Patients who you determine are complex and/or vulnerable but who are not referred from the Health Care Connect list
• Patients from the Health Care Connect list who are not identified as complex and/or vulnerable by Health Care Connect or by you

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 completed 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 patients from HCC who you later determine are complex and/or vulnerable, you must keep documentation of the rationale for the decision to bill the code (i.e. how the patient was more complex and/or vulnerable than indicated in their HCC patient health history). The ministry reserves the right to request this documentation. 

How to bill unattached patient fee codes for HCC patients

For each new patient from the HCC list, you will need to submit an enrolment fee code (i.e., Q200A, $0) and an unattached patient fee code.

The specific unattached patient fee code to use for patients from HCC will depend on whether the patient is identified as ‘complex/vulnerable’ (by either HCC or by the physician) or not. Refer to the table below.

Note that the service date on claims for the new patient attachment bonus (Q027/Q037) must be the same as a date where you provided an insured service in person. Claims for Q053/Q058 can use any date.

Select mothers and newborns

New one-time fees are available as of Nov. 1, 2026, for enrolling select mothers and newborns who enrolled since July 1, 2025.

• Q051A — Mother newborn new patient fee ($350) 
• Q052A — Multiple/newborn new patient fee ($150)

Eligibility

• Q051A — Mother newborn new patient fee: for enrolling both an unattached mother and newborn within two weeks of birth, or an unattached woman after 30 weeks of pregnancy
• Q052A — Multiple/newborn new patient fee: in the case of multiple births (e.g. twins, triplets, etc.), this code can be billed for each additional newborn attached after delivery

Required documentation

Have the patient sign and date both the New Patient Declaration and the Enrolment and Consent (E/C) forms on their first visit. Forms may be signed electronically.  

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

How to bill the mother/newborn new patient fees

For each eligible new patient, including the mother and newborn(s), you will need to submit an enrolment fee code (i.e., Q200A, $0) and an unattached patient fee code.

For Q051A

• The mother and newborn must be enrolled (i.e., Q200A submitted) within two weeks of birth 
• Bill Q051A under the mother. The health number used on the Q051A claim must belong to a female patient. 
• Any date can be used on the Q051A claim (it doesn’t have to be the date of a service provided)

For Q052A

• Each additional newborn must be enrolled within 90 days of birth
• Claims for Q052A must use each additional newborn’s health number
• You have up to 12 months after birth to submit the claim for Q052A 
• Any date can be used on the Q052A claim (it doesn’t have to be the date of a service provided)

Case example

An unattached mother who delivers twins would be billed as:

• Q200A + Q200A + Q200A = $0
• Q051A ($350) + Q052A ($150) = $500

The mother and first twin must be enrolled within two weeks of birth to be eligible for these payments. The second twin must be enrolled within 90 days of birth and the unattached patient fee code for them (Q052A) must be claimed before they turn one year old.

Unattached patient from hospital fee

This one-time fee is available for enrolling new, unattached patients who had an acute care hospital in-patient stay within the previous three months of enrolment.

Fee code: Q023A

Fee: $150

Eligibility

The patient must have been unattached at the time of enrolment, and have had an acute care hospital in-patient stay within the past three months. 

• An acute care in-patient stay is a stay of at least one night in hospital as an in-patient for an acute illness
• Emergency department visits and day surgery stays do not qualify

Q023A can only be claimed for newborns if:

1. the mother does not have a family physician; and
2. the newborn has been admitted to a Level II or higher Neonatal Intensive Care Unit (NICU) within the last three months

Required documentation

Have the patient sign and date both the Unattached Patient Declaration and the Enrolment and Consent (E/C) forms, within three months of discharge from the in-hospital visit. Forms may be signed electronically.

The patient is given a copy of the completed 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.

How to bill for the unattached patient from hospital fee

• You must submit both Q023A and an enrolment code (i.e., Q200A) for the same patient
• Q023A and the enrolment code must be submitted on the same claim with the same service date
• The service date of a Q023A claim must be the same as the date on the E/C form and the Declaration form
• There are no limits on the number of patients you can claim Q023A for in a year

New patient fee FIT positive/colorectal cancer increased risk 

This one-time fee is available for enrolling a new unattached patient through the ColonCancerCheck program. This includes patients with an abnormal FIT result or those at increased risk of colorectal cancer (CRC).

Fee code: Q043A

Fee:

• $150 (patient age < 65)
• $170 (patient age 65-74) 
• $230 (pateint age 75+)

Eligibility

The patient must be unattached and new to you and your group. They must be referred through the ColonCancerCheck program. This includes patients with an abnormal FIT result and those at increased risk of colorectal cancer (CRC).

Required documentation

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

How to bill for the new patient fee FIT positive/colorectal cancer increased risk

• You must submit both Q043A and an enrolment code (i.e., Q200A) for the same patient
• Q043A and the enrolment code (i.e., Q200A) must be submitted on the same claim with the same service date
• The service date of a Q043A claim must be the same as the date on the enrolment/consent form and the New Patient Declaration form
• If your software program does not support multiple amounts for the same fee code, you may bill the Q043A for $150.00 (the lowest value) and the ministry’s system will adjust it upwards accordingly
• There are no limits on the number of patients you can claim Q043A for in a year