The Ministry of Health and the Ontario Medical Association have introduced changes to how certain pre-operative and post-operative visits are billed under the 2024 Physician Services Agreement.
As outlined in OHIP INFOBulletin 260304, eligible services provided on or after April 1, 2026, may now be paid separately from the surgical fee.
What’s Changing?
Pre-operative assessment Surgeons can now receive full payment for eligible in-hospital pre-operative assessments performed 1–2 days before surgery. Previously, these visits could be included in the surgical fee or paid at a reduced rate.
Same-day surgery assessments
There is no change to the existing rules. Assessments performed on the day of surgery generally remain included in the surgical fee unless specific conditions allow separate payment.
Subsequent visits on the day of surgery
Certain subsequent visit codes can now be paid alongside the surgical procedure fee when billed by the same physician for the same patient on the same day, provided all OHIP requirements are met.
Post-operative assessments
Eligible in-hospital concurrent care and subsequent visits provided within two weeks after surgery can now receive full payment, where they were previously reduced or included in the surgical fee.
What Does This Mean for Physicians?
These changes may allow physicians to receive payment for eligible services that were previously bundled into the surgical fee or paid at a reduced rate.
Physicians should review the updated billing rules and eligible service codes to ensure claims are submitted correctly.
For full details, refer to OHIP INFOBulletin 260304.