FHO+: Hourly rate

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.

To bill the hourly rate fee codes:

• FHO signatory physicians can submit them with their FHO group number or solo billing number
• FHO locum physicians must submit them with the FHO group number

The categories of fee codes are:

Additional notes on teaching:

• The hourly rate can only be billed once by the FHO physician, regardless of how many learners you are teaching
• You cannot bill the hourly rate for care provided by your learners unless you are directly supervising them
• You can bill the hourly rate if you are actively supervising a learner live via video feed, as this is considered at the bedside
• You can bill the hourly rate for indirect care for activities done with your learner(s) as part of teaching after the patient encounter, such as reviewing lab results, preparing referrals, etc

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

Each category of 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 days, prorated monthly
• 25 per cent of your total billable hours monthly can be for indirect care and clinical administration (together)
• Five per cent of your total direct and indirect care hours monthly can be for clinical administration

This means that for every three hours of direct care, you can bill one hour of indirect care and/or 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.

The maximum billable hours for each category are for a pro-rated monthly period. This means that if you go over in one category one week, you can compensate by working fewer hours in this category another week in the same month.

The maximum number of hours payable per month is 240 hours per 28 days, prorated by the number of days per month.

Timing of payments

Starting April 1, 2026, hourly rate claims will be paid the same as regular OHIP claims.

Starting April 1, 2027, hourly rate claims will be paid similar to capitation payments, on a whole-month basis. Hourly rate billings submitted in one month will be paid in full in the next month. For example, billings submitted on April 30 will be paid in May.

Stale date rules will apply to the hourly rate. This means that you will have up to 90 days to submit claims for the hourly rate.

Billing notes for April 1, 2026

• As of April 1st, the only limits that will be programmed into the ministry system are the maximum 14 hours per day and the prorated maximum of 240 hours per month
• The percentage caps (25 per cent indirect + clinical administrative, and 5 per cent clinical administrative) will not be programmed in the ministry’s billing system until Year 2. For Year 1, if you go over these percentages, you will be paid for what you submitted and the ministry will reconcile any overpayment at a later date. Members are encouraged to keep track of their ratios on a monthly basis
• For Year 1 (April 1, 2026 to March 31, 2027), claim submissions that will take you over the hourly limit will be rejected. For example, if you previously submitted 220 hours and then submitted a claim for 30 hours (20 direct care, 10 indirect care), the full 30 hours will be rejected. For Year 2 (starting April 1, 2027), only the hours above the monthly limit will be rejected (e.g., 10 hours in the example)

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.

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.    

Documentation requirements

You are free to document this information wherever you choose, using whatever method works best for you.

Similar to documentation for other insured services, the ministry may request copies of your records or other information to demonstrate the work billed for a given day.

On a daily basis, you must document both total hours worked in each category, and, for indirect care and clinical administration, you must document a list of activities you did.

Hours

For each day that hourly rate claims are submitted, you must maintain records of your total time spent on care for enrolled patients in each of the following categories:

• Direct patient care
• Direct patient care provided by phone when out of the office
• Indirect patient care
• Clinical administration

Tips:

• For time documentation, only the total daily duration needs to be recorded for each category; start and stop times are not required
• Documentation does not need to be at the patient level. Only your time (the physician) can be counted. Time spent by delegates is not eligible for the hourly rate
• Time recorded should be for actual work done, not time scheduled

List of activities

For the indirect care and clinical administration categories, you must also document a daily list of activities associated with each category. For example, “April 1 – Indirect Patient Care – reviewed charts, sent referrals, reviewed lab results.”

Tips:

• The list of activities for each category (indirect care, clinical administrative time) does not need to be broken down to time spent per individual activity
• Documentation does not need to be at the patient level (for indirect care; the clinical administration time is across the roster or all FHO patients)

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

Application of the hourly rate

Home care 

When doing home visits to 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 enrolled patients, provided the locum is registered through the proper channels with the FHO. Learn more about registering a locum.

Income stabilization physicians

Physicians who are part of the income stabilization program are not eligible to bill the hourly rate.