For Ontario’s Emergency Department (ED) physicians and consulting specialists, 2026 marks a watershed moment in medical compensation. We have moved past the temporary “relativity adjustments” of 2024 and 2025 into a permanent, restructured fee schedule that demands a higher level of administrative precision.
At Bill Medics, we’ve analyzed the April 1, 2026, Fee Schedule Master (FSM) updates to help you navigate these changes, maximize your revenue, and maintain audit-proof documentation.
The 2026 Permanent Fee Adjustment
Effective April 1, 2026, the temporary relativity-adjusted increases from the previous two years have been replaced by permanent fee code adjustments. This shift represents the Year 3 implementation of the 2024-2028 Physician Services Agreement (PSA), resulting in an average compounded increase of approximately 5.37% across all specialties, though many individual ED assessment codes have seen targeted boosts of 10–14%.
Updated 2026 Assessment Values
To ensure your claims are processed accurately, you must update your EMR and billing software to reflect the latest values for the most frequent ED encounters:
| Fee Code | Service Description | April 2026 Value | Previous (Oct 2025) |
| A003 | General Assessment | $95.60 | $87.35 |
| A007 | Intermediate Assessment / Well Baby | $44.55 | $37.95 |
| H065 | Consultation in Emergency Medicine | $95.60 | $81.25 |
| H102 | Comprehensive Assessment and Care | $56.70 | $43.05 |
| H101 | Minor Assessment | $22.65 | $17.10 |
| A001 | Minor Assessment | $26.80 | $23.75 |
Strategic Changes to the “ED Enhanced Shadow-Billing Premium”
The ED Enhanced Shadow-Billing Premium has entered its most critical phase. As of April 2026, the first semi-annual payments (covering the 2025 period) are appearing on Remittance Advice (RA) reports under the accounting adjustment “ED ENHANCED SHADOW-BILLING PREMIUM”.
Key 2026 Requirement: For services rendered on or after April 1, 2026, your claims must contain the Ambulatory Care (AM) Master Number (MNI) of the specific ED site where the service was provided to remain eligible for this tiered premium.
The tiered payment structure remains focused on rewarding high-volume practitioners:
- 1–250 Encounters: 0%
- 251–500 Encounters: 6%
- 501–750 Encounters: 8%
- 751–1,000 Encounters: 10%
- 1,001+ Encounters: 12% (Annual cap: $40,000)
Special Visit Premiums (SVPs): The 2026 Tables
The mechanics of Table I (Consultants) and Table V (ED Staff) remain the gold standard for after-hours work. For 2026, the dollar values for the premiums are stabilized, but the maximum limits per time period are being strictly enforced by automated Ministry monitoring.
Table I & V Premium Values (2026)
- Travel Premium (K960–K964 / H960–H964): $36.40
- Nights (K996 / H986): $100.00 (Unlimited encounters)
- Weekends & Holidays (K998 / H988): $75.00
- Evenings (K994 / H984): $60.00
Documentation Alert: To survive an audit, your records must identify the time of request, the time of arrival, and the specific medical necessity that made the visit non-elective (i.e., the condition could not wait 24 hours).
The New Frontier: Nurse Practitioners and Surgical Unbundling
Two major shifts in the broader healthcare landscape are impacting ED workflows in 2026:
- NP Integration: Effective April 1, 2026, Nurse Practitioners (NPs) are eligible to bill OHIP for medically necessary primary care services with public funding parity. This means patients no longer face out-of-pocket fees for NP-led care, and ED teams must ensure collaborative billing models reflect this new provider status.
- Surgical Unbundling: Pre-operative and post-operative care and visits have been officially unbundled from the surgical benefit as of April 1, 2026. For specialists called to the ED for urgent procedures, this requires a more granular approach to billing the initial assessment alongside the surgical code.
Technical Compliance: The SLI and MNI Codes
Claim refusals in 2026 are frequently linked to “V68” (Invalid Service Location Indicator) or missing technical codes.
- HED: Use this SLI for all Hospital Emergency Department claims.
- OTN: Use this for virtual consultations initiated within the ED (accompanied by modifiers 93 for audio or 95 for video).
- MADJ: Be aware that “Medical Claims Adjustments” may appear on your RA due to staged implementation of the new fee schedule; these are often retroactive corrections and do not always indicate an error on your part.
Why Partner with Bill Medics?
As the complexity of OHIP billing moves from manual spreadsheets to analytical, software-driven oversight, the risk of “losing” revenue to underbilling or technical rejections is at an all-time high. Bill Medics offers a 0% cancellation rate and a 99% accuracy rate, backed by dedicated specialists who understand the 2026 Fee Schedule Master.
From ensuring your AM MNI is correctly attached to your shadow-billing claims to reconciling the new Year 3 PSA increases, we manage the complexity so you can focus on the patient.
Secure your 2026 Revenue Cycle. Contact Bill Medics for a free medical billing review today. Phone: +1 437-777-1920 | Email: info@billmedics.ca | Location: 150 King Street West, Toronto