Effective April 1, 2026, Ontario’s OHIP fee schedule changes take effect. Clinics must import the updated Physician Fee Schedule Master and ensure billing software is updated by April 10, 2026 under INFOBulletin 260403. - Effective date for fee changes: April 1, 2026. - Billing software must be updated by: April 10, 2026. - Ministry bulletin: INFOBulletin 260403 (Claims Services Branch). - Official place to download: https://www.ontario.ca/page/ohip-schedule-benefits This guide walks clinicians, clinic managers and billing staff through how to get the updated Physician Fee Schedule Master file, update billing workflows, interpret fee and eligibility rules in practice, and avoid common billing mistakes.

Why this matters in 2026

The OHIP Schedule of Benefits lists insured services, fee codes and the CAD rates physicians and other providers can claim from the Ontario Ministry of Health. Changes to the Schedule generally take effect on the province’s fiscal-year start. April 1. For 2026 the ministry issued an INFOBulletin (260403) announcing updates to the Physician Fee Schedule Master and required billing-software updates.

Prerequisites

Point is, before you begin the steps below make sure you have:

- A current OHIP billing number and practice account with the Ministry of Health.

- Access to your practice’s billing software and administrative rights to install updates.

- A copy of the clinic’s billing policies and any third-party billing agreements (to check whether changes affect private billing).

- Contact details for your software vendor and the ministry’s Service Support Contact Centre (1-800-262-6524, 8:00 a.m., 5:00 p.m. ET).

Step-by-step: get and apply the 2026 fee schedule

Follow these steps to find the updated Schedule of Benefits, load the new Physician Fee Schedule Master, and verify claims.

1) Find the official schedule and bulletin

- Go to the ministry’s Schedule of Benefits page: https://www.ontario.ca/page/ohip-schedule-benefits. That page lists the OHIP physician fee schedule, specialty schedules and links to INFOBulletins.

- Look for INFOBulletin 260403 (issued April 1, 2026). The bulletin confirms which fee codes changed and the timeline for the update.

2) Download the Physician Fee Schedule Master (FSM)

- The ministry posted the updated FSM on or about April 10, 2026. Download the FSM file and any companion CSV or XML files the ministry supplies for billing vendors.

- Save a copy in your clinic’s document repository. Keep the original file name and date stamp for audit trails.

3) Coordinate with your billing software vendor

- Tell your vendor that Bulletin 260403 requires a software update by April 10, 2026. Many vendors issued patches; others provide an import routine for the FSM. If your vendor has a hosted/managed solution, confirm they pushed the update.

- Ask the vendor for release notes showing which fee codes and values changed. Keep those notes with your billing records.

4) Import the FSM and run test claims

Mastheads

- Import the FSM into your billing system following vendor instructions. If your software has a sandbox mode, run test claims dated April 1, 2026 or later to confirm codes and amounts load correctly.

- Compare a sample of claims to pre-update amounts to identify significant rate changes. Document any unexpected differences.

5) Update clinic billing policies

- Adjust internal fee schedules, consent forms and front-desk scripts if the update changes the amount patients might owe for uninsured services or add new insured items your clinic will provide.

- Note: OHIP-insured services remain billed to the ministry; non-insured or partly insured services must be handled as private charges consistent with ministry and regulatory guidance.

6) Submit claims and reconcile

- Submit claims electronically via your billing software to the ministry’s claims service. Monitor the first run of real claims for rejections, partial payments or new adjudication messages.

- Reconcile payments against expected fee amounts. Investigate any variances promptly, most issues are coding or version mismatches.

Eligibility, costs and fees (what to expect)

OHIP covers insured medically necessary physician services for eligible Ontario residents. Key eligibility and cost points to remember:

- Residency: Most new Ontario residents face a three-month waiting period before OHIP coverage begins. That three-month rule is a longstanding requirement and applies to people establishing primary residence in Ontario. Temporary workers, international students and visitors may have different arrangements, verify coverage before treating if billing is unclear.

- Health card: Patients must present a valid Ontario health card (photo or paper, depending on the card type) for OHIP billing. Clinics should record health card numbers and expiry dates before submitting claims.

- Insured vs non-insured services: OHIP pays only for insured services listed in the Schedule. Cosmetic procedures, most non-therapeutic services and services provided for employment or insurance forms may not be insured and can be billed privately. Check the Schedule before charging patients directly.

- Fees are paid in Canadian dollars (CAD). The FSM provides per-code amounts and modifiers that determine payment levels. The only guaranteed figures in this guide are the effective date (April 1, 2026) and the ministry’s required update date (April 10, 2026); see the FSM for per-code CAD amounts.

Each province manages its own fee schedule. If a patient moves or seeks care across provinces, note that fee codes and rates differ. For example, British Columbia’s Medical Services Plan and Alberta’s schedule use different code sets and payment models. If your clinic works with out-of-province patients, verify coverage and submit claims as the patient’s home province requires.

- Start early: download the FSM as soon as it’s posted and read the ministry’s INFOBulletin carefully.

- Use a test environment: import the FSM into a sandbox or staging instance first, then validate coding and totals before pushing to production.

- Keep version control: store copies of each year’s FSM and release notes. That makes retroactive audits and chart reviews easier.

- Communicate with staff: front desk, clinical and billing staff should know which services remain insured and which are private. Update intake forms if necessary.

- Track ministry messages: subscribe to ministry INFOBulletins and the OHIP updates page to catch mid-year technical fixes or clarifications.

- Missing the April 10 update window: failing to update billing software on time can cause mispriced claims, rejections or payment delays. The ministry flagged April 10, 2026 as the date by which vendors and clinics should have the updated FSM implemented.

- Using old fee codes: coding an April 2026 service with an obsolete code may lead to rejections. Always confirm code validity for the service date.

- Billing insured services privately: don’t charge patients for services that are OHIP-insured. If a service is only partly insured, get informed written consent before charging the patient for the remainder.

- Not reconciling adjustments: small differences in fee amounts can accumulate. Reconcile payments against expected rates at least monthly for the first quarter after any major update.

- OHIP Schedule of Benefits page: https://www.ontario.ca/page/ohip-schedule-benefits. This is the official landing page for fee schedules and the downloadable FSM.

- INFOBulletins: check the ministry’s OHIP INFOBulletins list and locate bulletin 260403 for the April 2026 update specifics and vendor instructions.

- Service Support Contact Centre: call 1-800-262-6524 (8:00 a.m., 5:00 p.m. ET) for billing questions and technical support. Keep your clinic's billing number and a summary of the issue handy when you call.

Related Articles

The 2026 OHIP Schedule of Benefits changes take effect on April 1, 2026, and the ministry-directed FSM must be imported and applied by April 10, 2026, per INFOBulletin 260403. Clinics should confirm their vendor pushed the update, run test claims in a sandbox, and keep the FSM file plus vendor release notes for audit trails. If you run into discrepancies, contact your billing vendor and the ministry’s Service Support Contact Centre for resolution.

This article was created with AI assistance.