Unattached patient fees: Frequently asked questions

There are several different one-time fees available for enrolling new unattached patients. Some of them have been in effect for some time. Others are new, and effective as of July 1, 2025.

Family medicine physicians in all patient enrolment models (PEM) are eligible to claim these fees, subject to the rules that apply for each. Locums working in a PEM are not eligible to claim these fees.

The fee codes marked as ‘new’ are available as of Nov. 1, 2026.

Each fee code has specific requirements to fulfil, which includes, completing the appropriate patient declaration form. All newly enrolled patients and the physician must complete the Patient Enrolment and Consent to Release Personal Health Information form (“E/C Form”).

To bill, the physician must enrol the patient using the appropriate fee code (e.g. Q200A) and submit the relevant billing code. Only one unattached patient fee code can be used per patient per group.

There are two fee codes for the new patient attachment bonus: one for established physicians and one for new graduates (as defined). For the applicable code, claim the lowest fee value and the ministry will adjust the payment based on the RIO score of the physician or group (whichever is higher) and the patient’s age at the time of service.

Q027A: Established doctor in a patient enrolment model

Q037A: New graduate in a patient enrolment model

The new Q058A HCC Complex/Vulnerable Unattached New Patient Fee is worth $500.

It is for enrolling unattached patients from the Health Care Connect waitlist who:

• are identified by Health Care Connect as complex and/or vulnerable, or
• were not identified as complex and/or vulnerable by HCC, but whom you later determine are complex and/or vulnerable.

Q058A replaces the previous HCC Complex-Vulnerable Patient Fee code (Q053). 

Q051A—Mother newborn new patient fee ($350) is available 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 ($150) is available for enrolling each additional newborn attached after delivery in the case of multiple births (e.g., twins, triplets, etc.). 

Newborns are only eligible for an unattached patient fee in the following cases: 

• When both a newborn and unattached mother are enroled together (bill Q051A)
• For each additional newborn attached in the case of multiple births (bill Q052A)

If any of your existing patients, enroled or not, have a new baby, that baby would not be considered a new patient for the purposes of this fee. 

The patient must be new to the physician and new to the group.  

In addition, as outlined in the New Patient Declaration form and the Unattached Patient Declaration form, a new patient is one who has never had a family physician or one who does not currently 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 

You may rely on the information the patient shares for purposes of the declaration form. It is always best practice to document what the patient told you and note the forms that were completed, including the New Patient Declaration form or the Unattached Patient Declaration form.

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 unattached patient fees.

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 (including the patient attachment bonus) 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)

You can ask the patient and rely on their response. Best practice would be to document the question in the patient chart. Currently, there is no central place where you can check if the patient is enroled anywhere else.

Yes, as long as the physician who passed away was not a member of the group of the enrolling physician. One of the criteria on the form is ‘The patient’s physician is no longer available due to illness/death/retirement.’ As such, if this clause is met you can bill an unattached patient fee for this patient.

Note that unattached patient fees do not apply to a batch roster transfer. Therefore, if a physician passes away and you take their entire roster, you cannot claim any unattached patient fees (including the patient attachment bonus) for those patients.

Yes. One of the criteria on the New Patient Declaration form is ‘The patient has moved to another community’. 

No. If the patient has ever been enroled to you – in any group – you cannot claim an unattached patient fee for them.

No. If an unattached patient fee code (including the patient attachment bonus) is billed by any member of the group for a specific patient, no unattached fee code can be billed again for the same patient within the same group.

Unattached patient fee codes, including the new patient attachment bonus, are intended to encourage PEM physicians to enroll new unattached patients to their practice.

To be eligible for any of the unattached patient fees, patients must be unattached, new to the physician and new to the group (refer to the first question in the eligibility section for criteria). The patient must also meet any other criteria related to the specific fee (e.g., HCC ‘complex/vulnerable’, mother/newborn, etc.).

If you have seen a patient serially (i.e., in an ongoing manner, with the intention of having them be a part of your practice), then they would not be considered “unattached.”

No. Unattached patient fees, including the patient attachment bonus, do not apply to the scenario of taking over a physician’s entire roster (i.e., a batch roster transfer). In this situation, you cannot bill any unattached patient fees for any patient on the batch roster.

Yes. As long as:

1. They are new to you and new to your group 
2. They are unattached (see New Patient Declaration form) 
3. They, or their substitute decision makers, complete the requisite forms
4. You enrolled them on or after July 1, 2025, and submitted the relevant enrolment code (Q202)

Additional notes: 

To receive any of the unattached patient fees, including the patient attachment bonus, all eligibility criteria must be met. Specialized unattached patient fees (i.e., Q058A HCC complex/vulnerable) have additional specific requirements.  

If you want to claim the new patient attachment bonus, remember the service date on the claim for the bonus must be equal to the date of an insured service provided in the usual family practice setting (i.e., not virtual) on or after enrolment.

Patients from the HCC list are eligible for an unattached patient fee if:

1. They are new to you and new to your group 
2. They are unattached (see New Patient Declaration form) 
3. They complete the requisite forms 
4. You enrolled them on or after July 1, 2025, and submitted the relevant enrolment code (Q200A)

To be eligible for the new ‘HCC complex/vulnerable’ fee code (Q058A), patients must also:

• Be referred from the HCC list, and
• Have been determined to be ‘complex/vulnerable’ either by HCC or the physician. 

If the HCC-based patient is not considered ‘complex/vulnerable’, they may still be eligible for the new patient attachment bonus.

Note that only one unattached patient fee code can be claimed per eligible patient.

No. Physicians working in a Patient Enrolment Model (PEM) can bill an unattached patient fee code as long as they meet the general eligibility requirements, satisfy the billing rules, and meet any other criteria related to the specific unattached patient fee code.

New patients can come from the HCC list or elsewhere.

No. The new Health Care Connect Complex/Vulnerable Unattached New Patient fee only applies to patients from the HCC list who:

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

New complex/vulnerable patients who come to you from somewhere other than the HCC list referral are not eligible for this fee. They may be eligible for the new Patient Attachment Bonus. 

All patient enrolment models are eligible for unattached patient fee codes, including:

• BSM: Blended Salary Model
• CCM: Comprehensive Care Model
• FHG: Family Health Group
• FHN: Family Health Network
• FHO: Family Health Organization
• GHC: Group Health Centre
• GP-HIV: General Practitioner Specialized Model for HIV Patients
• GP Focus Care of the Elderly
• RNPGA: Rural and Northern Physician Group Agreement
• Rural Generalist Model
• Sioux Lookout Regional Physician Services Incorporated – also known as Sioux Lookout Agreement
• St. Joseph’s Primary Care Site at St. Joseph’s Hospital in Toronto
• WAHA: Weeneebayko Health Authority

No. Locums cannot bill the unattached patient fee codes, including the patient attachment bonus. They must be billed by the enrolling physician.

Yes, provided all criteria is met, physicians on Income Stabilization are eligible for all unattached patient fees, including the patient attachment bonus.

Yes. Practice Ready Ontario physicians are eligible to claim unattached patient fees, including the patient attachment bonus, if they are:

1. in the Return of Service portion of the program and hold a provisional certificate to practice under supervision at a specific location, AND
2. a member of a Patient Enrolment Model

For the purposes of the new patient attachment bonus, Practice Ready Ontario physicians are considered New Graduates if they have joined a PEM within three years after receiving their CPSO number.

New graduate eligibility begins when you join the PEM and continues for 12 months.
Only one unattached patient fee can be claimed per eligible patient, in addition to other rules set out in the PEM contracts.

No. Physicians working in a Patient Enrolment Model (PEM) may only claim unattached patient fee codes, including the patient attachment bonus, for eligible patients who were enrolled on or after the date they joined a PEM or that their group’s PEM status was received.

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.

An established physician is a physician who has practised medicine for at least 3 years and one day since licensure (e.g. licensed to practice independently).

No, only those physicians that have completed family medicine postgraduate training and received a license to practice within the previous three years are considered a new graduate. In this case, you would be eligible for the established physician rate.

You can use the OMA RIO lookup tool to help estimate your RIO score.

If there is no RIO score, your claims will default to the payment value attributed to RIO <40. This will occur if neither you nor your group have a RIO score assigned.

No, the consistent rule across all unattached patient fee codes, including the patient attachment bonus, is that only one can be billed per patient per group. If two are submitted for the same patient (e.g., a new patient attachment bonus Q027 and the HCC attachment code Q058A), the ministry will pay the first one processed (assuming eligibility criteria are met).

The only exception to this is mother newborn and multiple newborn, which can be billed together when applicable.

All unattached patient fees require that the eligible patient is enrolled to the physician and that the relevant enrolment code is billed (e.g., Q200A).

Access step-by-step instructions on how to bill the patient attachment bonus.

Access step-by-step instructions on how to bill specialized unattached patient fees (including Mother/Newborn, Multiple/Newborn fees, and the new Health Care Connect Complex/Vulnerable).

Assuming the requirements of the fee code are met, there is no limit on how many patients you can bill an unattached patient fee, including the new patient attachment bonus, for.

Note that only one unattached patient fee code can be billed per patient per group. In addition, patients attached as part of a batch roster transfer are not eligible.

The new unattached patient fee codes. including the new patient attachment bonus,  are are available to bill as of Nov. 1, 2026.

You have until the May 2027 claims processing cut-off (typically around the 18th of the month) to submit all retroactive claims for unattached patient fees (for patients enrolled between July 1, 2025 to Oct. 31, 2026 inclusive).

For patients enrolled on or after Nov. 1, 2026, regular stale-dating rules apply, and claims must be submitted within three months.

No. The new unattached patient fees only apply to eligible patients rostered from July 1, 2025, forward.

Yes. Specifically, you will be able to retroactively claim the following for new, unattached patients who were enrolled between July 1, 2025 and Oct. 31, 2026 (inclusive) where the relevant requirements have been met:

• Q027/Q037 — new Patient Attachment Bonus 
• Q058A — the Health Care Connect – Complex/Vulnerable fee
• Q051A — Mother newborn new patient fee
• Q052A — Multiple/newborn new patient fee

You have until the May 2027 claims processing cut-off (typically around the 18th of the month) to submit all retroactive claims. Note that regular stale-dating rules still apply to the enrolment codes (e.g., Q200A) and all insured services provided to these patients.

For patients enrolled on or after Nov. 1, 2026, regular stale-dating rules apply, and claims for unattached patient fees, including the new patient attachment bonus, must be submitted within three months.

Only one unattached patient fee code can be billed per patient.

If two codes are submitted for the same patient (e.g., a new patient attachment bonus code Q027A and a Health Care Connect Complex/Vulnerable attachment code Q058A) the ministry will pay the first one processed (assuming requirements were met).

The only exception to this is mother newborn and multiple newborn fee codes, which can be billed together when applicable.

No. If you are taking over a physician’s roster and there is no break in attachment, the patients are not "unattached," which is the purpose of these fees.

Non-complex patients from the HCC list are eligible for the new patient attachment bonus if:

• they are new to you and new to your group, and
• they are unattached (see New Patient Declaration form), and
• they complete the requisite forms, and
• you enrolled them on or after July 1, 2025, and
• they have had at least one in-person insured service visit (i.e., not virtual) on or after enrolment.

Bill the following codes:

1. The appropriate attachment code at time of enrolment (e.g., Q200)
2. The relevant new patient attachment bonus fee code (Q037A new graduate or Q027A established physician) with a service date equal to the date of any insured service provided in the usual practice setting (not virtual) on or after enrolment

Yes. You must submit the appropriate enrolment code (e.g. Q200A) for all enroled patients. These zero-value fee codes tell the ministry which patients are rostered to you. They must be submitted in order to be eligible for the new patient attachment bonus or any unattached patient fee.

No, the patient attachment bonuses need to be claimed the same day as any insured service provided in the usual family practice setting (i.e., not virtual), either on or after the date of enrolment. The visit does not need to be the “first” visit.

Note: the specialized unattached patient fees do not require a service visit.

If the physician chooses to de-enrol a new patient within 12 months of formal enrolment, the fee for the unattached patient fee will be recovered.

You must be a member of a Patient Enrolment Model to enrol patients. Locums working in a PEM are not eligible to enrol patients.

To enrol a patient:

1. Have the patient complete, sign, and date the Patient Enrolment and Consent to Release Personal Health Information form.
   • Ensure the date on the enrolment form matches the date the enrolment fee code is submitted (e.g., the Q200A submission date)
   • Give the patient a copy of the completed form; retain a copy of it for your records for audit purposes
2. Submit the appropriate enrolment fee code (e.g., Q200A)

• Use the New Patient Declaration Form for all enrolment fee codes, except when the enrolment is related to a recent acute inpatient stay
• Use the Unattached Patient Declaration Form for enrolments related to a recent acute inpatient stay (i.e., when billing Q023A)

The New Patient Declaration form is not needed for normal enrolment; it is only needed for claiming the patient attachment bonus or an unattached patient fee. 

The declaration enables you and the patient to confirm that the patient is indeed unattached (i.e., is not currently under the care of another Ontario family physician). It also confirms that you accept the patient into your practice. 

For prospectively enrolled patients:

• You can either email the New Patient Declaration form to the patient and have them sign it, or you can have them sign and date the form on their first visit

For retroactively enrolled patients (July 1, 2025 to Oct. 31, 2026):

• You have until Oct. 31, 2027 to have them complete the New Patient Declaration form

Yes, the New Patient Declaration form can be signed electronically by the patient and sent back to the physician, or the patient can sign in-person.

Give the patient a copy of their completed Enrolment and Consent form. 

Keep copies of both completed forms on file for audit purposes. They do not need to be submitted to the ministry. Electronic copies are sufficient; paper copies do not need to be kept.

The ministry will periodically review claims for unattached patient fees. The review may include an audit of signed and dated New Patient Declaration forms, or contact with either the physician or patient to verify the accuracy of the claims for unattached patient fees.