Regulation - LGIC

Amendment to Payments for Physician Services

Regulation Number(s):
Instrument Type:
Regulation - LGIC
Bill or Act:
Health Insurance Act
Summary of Decision:
Regulation Change approved
The regulatory amendment which provides a 2.65% across the board fee reduction on all FFS physician payments is effective February 1, 2015.

The regulatory amendments to the Schedule are effective April 1, 2015.
Further Information:
Proposal Number:
Posting Date:
Summary of Proposal:
The Ontario Health Insurance Plan covers payments for medically necessary physician services, prescribed hospital and health facility services. Regulation 552 and The Schedule of Benefits for Physician Services ("Schedule") lists the physician services that are insured under Ontario's Health Insurance Act (HIA). Changes have been made to Regulation 552 resulting in changes to fee for service payments to physicians.

Effective February 1, 2015 a 2.65% payment discount will be applied on all fee-for-service (FFS) physician payments.

Effective April 1, 2015 the following changes to the Schedule will become effective:

1. Emergency department equivalent - partial assessment (A888). The fee is reduced
from $35.40 to $33.70.

2. Chronic Disease Premium (E078) will no longer be payable for services provided
by 13(Internal Medicine), 16(Nephrology), 41(Gastroenterology) or 60(Cardiology).
Contact Address:
Health Services Branch
1055 Princess Street, 3rd Floor
PO Box 168
Kingston Ontario K7L 5T3
Effective Date:
January 29, 2015