If you’ve welcomed new patients into your practice since July 2025, you may have thousands of dollars in payments waiting to be claimed. As of November 1, 2026, Ontario family physicians can bill the new patient attachment bonus fees introduced under the 2024–2028 Physician Services Agreement (PSA). These fees provide additional compensation for enrolling patients who do not currently have a family doctor, with payments retroactive to July 1, 2025.
Each fee comes with specific billing rules, and the window for retroactive claims closes in May 2027. This guide covers the new fee codes, who qualifies, and how to bill correctly, so no eligible payment goes unclaimed.
What Are the New Patient Attachment Fees?
Patient attachment fees are one-time payments to eligible family physicians who enroll unattached patients into their practice. Several new fees were introduced under the 2024–2028 PSA, and they sit alongside two existing fees that remain in effect.
Fee code | Description | Value |
Q027A | Patient Attachment Bonus – established physician | $100–$180 |
Q037A | Patient Attachment Bonus – new graduate | $150–$270 |
Q058A | Health Care Connect complex/vulnerable patient fee (replaces Q053A) | $500 |
Q051A | Mother and newborn new patient fee | $350 |
Q052A | Multiple newborn new patient fee | $150 per additional newborn |
Q023A | Unattached patient from hospital fee (existing) | $150 |
Q043A | New patient fee – FIT positive/CRC increased risk (existing) | $150–$230 by patient age |
Relativity is already included in the value of the new codes, so you won’t receive it separately. Q023A and Q043A continue to be eligible for separate relativity payments.
Who Is Eligible to Bill the New Patient Attachment Fees?
These fees are available to family physicians in eligible Patient Enrolment Models (PEMs), including FHO, FHN, FHG, CCM, BSM, GHC, RNPGA and RGM.
Locums working in a PEM and nurse practitioners are not eligible, and if you practice in a CHC, a fee-for-service model or an IPHCO, you cannot claim these fees.
If you’re on Income Stabilization, submit these codes using your group number to avoid claim rejections.
Which Patients Qualify as Unattached?
A patient qualifies when they are new to you and your group and do not have a family physician. On the declaration form, your patient confirms:
- that their previous family physician has moved or is no longer available (due to illness, death, retirement or a change of practice)
- that they have moved to a new community
- or that they have not previously had or felt the need for a family physician.
Patients previously enrolled to the physician or group, transferred within the same group, or who already have a family physician in their community generally do not qualify.
Note: Only one unattached patient fee is payable per patient, per group, except for the multiple-birth combination of Q051A and Q052A.
Understanding the Patient Attachment Bonuses (Q027A and Q037A)
The new Patient Attachment Bonus provides payments ranging from $100 to $270 for each eligible patient enrolled.
The amount depends on the patient’s age, the physician’s career stage, and the applicable Rurality Index for Ontario (RIO) score.
Patient age | Established physician (Q027A) | New graduate (Q037A) |
0–64 | $100–$150 | $150–$225 |
65 and older | $120–$180 | $180–$270 |
Higher amounts in each range apply to physicians with a qualifying RIO score of 40 or above.
New graduates are eligible for Q037A for 12 months after joining a PEM, provided they joined within three years of completing their qualifying family medicine training. Both bonus codes Q027A and Q037A expire on March 31, 2028.
Billing tip: Submit the lowest fee amount for the applicable code. The Ministry will automatically adjust the payment based on the patient’s age and RIO score.
Key Requirements for Billing
To successfully claim Q027A or Q037A, physicians must:
- Have the patient complete an Enrolment and Consent (E/C) form and a New Patient Declaration form.
- Submit the attachment bonus code with an in-person insured visit on or after the patient’s enrollment date.
- Use the same service date for both the attachment bonus and the qualifying visit.
- The qualifying visit can be fee-for-service or shadow billed, but virtual visits do not qualify.
The attachment bonus does not have to be billed with the patient’s first visit, as long as the patient is already enrolled. It is also important to be aware that payments may be recovered if you or your group de-roster the patient within 12 months.
Patient Attachment Billing Examples
Let’s look at three common scenarios to understand how these rules apply.
Example 1: Patient enrolls before their first visit
- August 1, 2026: The patient signs the enrollment forms but doesn’t need an appointment. The physician bills Q200A.
- November 1, 2026: The patient comes in for an in-person visit. The physician bills A007A and Q027A with this date.
Result: Paid. The bonus is billed on the date of a qualifying visit that happened after enrollment.
Example 2: Patient enrolls and is seen on the same day
- August 1, 2026: The patient visits the clinic with a medical concern and agrees to enroll. The physician bills Q200A, A007A and Q027A together.
Result: Paid. Enrollment and the qualifying visit happened on the same day.
Example 3: Patient enrolls after their visits
- August 1 and November 1, 2026: The patient is seen in person but isn’t enrolled yet.
- November 7, 2026: The patient signs the enrollment forms without a visit. The physician bills Q200A.
If the physician bills Q027A on November 7, it’s paid at $0 (DF) because there was no visit that day. If they bill it on November 1, it’s paid at $0 (I6) because the patient wasn’t enrolled yet.
Result: Not payable yet. The physician can bill Q027A at the patient’s next in-person visit.
How to Avoid Common Patient Attachment Claim Rejections
Even small billing errors can lead to rejected claims or missed payments. Here are some common mistakes to watch out for:
- Billing without a matching qualifying visit: Q027A and Q037A must use the same service date as an eligible in-person visit on or after enrollment, or the claim may be paid at $0 (DF or I6). Virtual visits do not qualify.
- Billing patients who don’t qualify: Patients previously enrolled with you or your group, transferred within the group, or who already have a family physician are not eligible.
- Submitting the wrong attachment code: Use Q027A for established physicians or Q037A for eligible new graduates, based on status on the service date.
- Missing enrollment documentation: Ensure patients complete both the Enrolment and Consent form and the New Patient Declaration form and retain copies in their records.
- Missing submission deadlines: Submit retroactive claims before the May 2027 processing cut-off. For new enrollments, regular 90-day claim submission rules apply.
Billing tip: Before submitting an attachment bonus, double-check the patient’s enrollment status, qualifying visit date, and required documentation to reduce the risk of rejections.
Your New Patient Attachment Billing Workflow
Previously, enrolling a patient generally involved completing the E/C form and billing Q200A. With the attachment bonus, physicians also need to account for the declaration form and a qualifying in-person visit.
For Patients Enrolled July 1, 2025 – October 31, 2026
- Identify patients rostered since July 1, 2025, without the patient attachment fee billed.
- Confirm eligibility and obtain the New Patient Declaration form. If it isn’t on file yet, you can still submit the claim, as long as the signed form is in the patient’s chart by October 31, 2027.
- Find a qualifying in-person visit on or after enrollment. Bill Q027A or Q037A using that visit’s service date.
- Submit retroactive claims before the May 27, 2027 claims processing cut-off.
For New Patients Going Forward
- Enroll the patient using Q200A and complete both the E/C and New Patient Declaration forms.
- Ensure the patient has a qualifying in-person insured visit on or after enrollment.
- If the visit is on the enrollment date, bill Q200A, Q027A (or Q037A) and the visit code (such as A007A) together.
- If the visit is later, bill Q200A on the enrollment date and Q027A (or Q037A) with the eligible in-person visit code on that later date.
- Submit the attachment bonus within the regular 90-day claim submission period.
Billing Workflow at a Glance
With the new patient attachment bonus, you need to include the New Patient Declaration form and a qualifying in-person visit in your patient enrolment process. Here’s how to manage past enrolments and new patients:
Other New Patient Attachment Fees
Q058A: Health Care Connect Complex/Vulnerable Patients
Physicians can now claim $500 for enrolling an eligible complex or vulnerable patient through Health Care Connect (HCC).
This replaces the previous Q053A fee of $350, effective November 1, 2026.
Physicians who previously received Q053A payments for eligible claims dating back to July 1, 2025, will automatically receive the additional $150 per claim from the Ministry.
Q051A and Q052A: Mothers and Newborns
Physicians can claim Q051A ($350) when enrolling an eligible unattached mother and newborn within two weeks of birth, or an unattached pregnant patient after 30 weeks of gestation.
For multiple births, Q052A ($150) can also be claimed for each additional newborn.
For example, a physician enrolling an eligible mother with twins can receive $350 under Q051A and an additional $150 under Q052A, for a total of $500.
Capturing Your Attachment Bonuses: How DoctorCare Is Supporting You
The new Patient Attachment Bonuses present a valuable opportunity for physicians to capture additional revenue, but they also add another layer of complexity to an already demanding billing process.
With more than a year of eligible enrollments to review, new documentation requirements, specific billing rules, and submission deadlines, identifying and claiming every eligible patient can be time-consuming.
That’s why our team is currently developing a solution to help you identify and capture every eligible attachment bonus, and we’ll be sharing more details soon. In the meantime, if you have any questions about the new fees or how they apply to your practice, please reach out to our team.
We’re here to help you navigate this new update every step of the way.
References
Ontario Medical Association – Unattached Patient Fees (November 2026).
Ontario Medical Association – The New Patient Attachment Bonus (November 2026).
Ontario Medical Association – Specialized Unattached Patient Fees (November 2026).
Information is based on Ministry of Health and OMA guidance available as of November 2026. Physicians should confirm current billing requirements before submitting claims.
