FHO+: Hourly rate

The new hourly rate of $80 will compensate FHO physicians for time spent providing direct and indirect patient care, as well as doing clinical administrative work. The hourly rate applies to all insured services for your FHO rostered patients, including both in-basket and out-of-basket codes. The ministry has also confirmed that care provided to rostered patients in long-term care will be eligible for the hourly rate.

If you currently work in a FHO, you will automatically be practicing under FHO+ with an hourly rate starting April 1, 2026.

In addition to the hourly rate, you can continue to shadow bill.

Services provided outside of the usual family practice setting are ineligible for the hourly rate. This includes:

  • Services provided in emergency departments
  • In-hospital services (e.g. hospitalist work, obstetrical care)
  • Anesthesia, surgical assist, IHF

Services to non-rostered or uninsured patients are also ineligible for the hourly rate.

Additional resources
FHO+ hourly rate reference guide
Hiring a locum considering FHO+ changes

Hourly rates

The hourly rates for physician time are as follows:

Direct patient care:

  • $80/hour: for care provided in-person or virtually, with the exception of telephone care provided when you are out of the office
  • $68/hour (85 per cent of $80/hour): for care provided by telephone when you are out of the office

Indirect patient care:

  • $80/hour

Clinical administration:

  • $80/hour

All services billed under the hourly rate are considered medically necessary and thus are exempt from HST. This includes direct patient care, indirect patient care and clinical administration.

Fee codes

There will be unique fee codes for each of the types of care eligible for the hourly rate:

Q310 – Direct Patient Care – In-Person or Video: All direct patient care that you provide to rostered patients, with the exception of telephone care you provide when you are out-of-the-office. Including:

  • Time spent personally delivering insured clinical services
  • In-person and virtual care
  • Clinical teaching done concurrently with patient care

Q311 – Direct Telephone-based Patient Care – Not in Office: Care you provide to rostered patients by telephone when you are out of the office.

Q312 – Indirect Patient Care: Time you spend on tasks associated with patient-specific insured services provided to rostered patients where there is no direct patient contact, such as:

  • Paperwork (e.g. charting and documentation; preparing referrals and requisitions; completing clinical forms, reports and medical certificates of death, excluding third-party requests)
  • Coordinating and planning care (e.g. chart reviews; reviewing results such as labs, imaging, consult notes)
  • Conferencing, consulting and meeting with other physicians and healthcare professionals for a specific patient or patients
  • Conferencing and meeting with family members and/or patient medical representatives
  • Discussion with, and providing advice and information to the patient or the patient’s representative that is an insured service directly related to pre- or post-direct patient care, via synchronous or asynchronous care communication
  • Reviewing clinical information or research directly related to the needs of a particular patient
  • Patient-specific clinical teaching to undergraduates, residents and/or fellows arising from direct patient care

The rate for indirect care is the same whether this is done while you are in-office or out-of-office.

Q313 – Clinical Administration Time: Time you spend on non-patient-specific tasks that require the professional expertise of a physician for management of your roster or all patients of the FHO, such as:

  • Proactive patient management (e.g. screenings, chronic disease)
  • EMR updates requiring physician expertise
  • Quality improvement initiatives
  • Clinic-based implementation work (e.g. change management for adoption of digital health tools)

Excludes non-clinical administrative tasks related to clinic management (e.g. HR, finance, supply ordering) and time spent documenting your hours.

The rate for clinical administration is the same whether this is done while you are in-office or out-of-office.

To recap, the following services are NOT billable using the hourly rate:

  • Care provided outside of the usual family practice setting (for example, services provided in emergency departments)
  • Care delivered by another team member (for example, delegated tasks, such as immunizations and injections done by nurses)
  • Care provided to non-rostered patients
  • Uninsured services (e.g. doctor’s notes, insurance forms, cosmetic procedures, etc.)
  • Non-clinical administrative tasks related to clinic management (e.g. HR, finance, supply ordering)

Billing units

The hourly rate is billed in 15-minute units, calculated cumulatively across the day. Any remainder of eight minutes or more will be rounded up to a full 15-minute unit.

Billing limits

You can bill a maximum of:

  • 14 hours on any one day
  • 240 hours over 28 consecutive calendar days (an average of 8.5 hours/day)
  • 25 per cent of your total billable hours (averaged over 28 days) can be for indirect care and clinical administration (together)
  • Five per cent of your total direct and indirect care hours (averaged over 28 days) can be for clinical administration

This means that for every three hours of direct care, you can bill one hour of indirect care and clinical administration (together). In other words, 33 per cent of direct patient care hours can be used to bill for indirect care and clinical administration.

Eligible hours calculator

Use this calculator to find your maximum billable hours for each category of direct patient care, indirect patient care and clinical administration, based on your total number of hours per week.

Note that in practice, there are no weekly limits, only daily and monthly. This calculator is intended as an illustrative example of how the percentage limits work.

Actual hours worked per week
Direct Care: In-Person   
Direct Care: Telephone Out-of-Office 
Indirect Care   
Clinical Administration   
Total Hours per Week   
Your hours eligible for billing % of time
Max Direct   
Telephone Out-of-Office
Max Indirect   
MAX CAT   
Maximum Allowable Billed   

In addition to the hourly rate for your work, you are paid shadow billing and other bonuses, so the hourly rate alone does not reflect your total compensation for work provided.

To see how the hourly rate affects your total income, visit the FHO+ calculator.    

Documenting your hours

You must maintain records of your total time spent in each category per day:

  • Direct patient care
    • Document care provided when you are in-office separately from care provided by telephone when you are out-of-office – these are different fee codes
  • Indirect patient care
  • Clinical administration

Only daily duration needs to be recorded; start and stop times are not required. Documentation does not need to be at the patient level.

Indirect care and clinical administration entries must include a daily description of activities associated with each category. For example, “April 1 – Indirect Patient Care – one hour – chart reviews”. Similar to documentation for other insured services, the Ministry may request copies of your records at any time.

We are working with OMD to provide you with tools to support you in documenting your hours.

Application of the hourly rate

Home care 

When doing home visits to your rostered patients, you can bill the hourly rate for time spent with the patient and any associated documentation or charting. Travel time is not billable using the hourly rate.

Locums

If you hire a locum to cover your FHO practice, the locum can bill and receive payment for the hourly rate when providing services to the FHO’s enrolled patients, provided the locum is registered through the proper channels with the FHO. Learn more about registering a locum.  

Published: Sept. 25, 2025  |  Last updated: Feb. 3, 2026