Regulation - LGIC

Nurse Practitioner Referrals: Changes to the Schedule of Benefits 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 for NP referrals to physicians for consultation is effective May 1, 2015.

The regulatory amendments to the Schedule are effective May 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 May 1, 2015, physicians may bill the appropriate consultation fee for patient referrals from a Nurse Practitioner. The proposed changes support direct referrals from NPs to a physician/specialist.
Contact Address:
Health Services Branch
1055 Princess Street, 3rd Floor
PO Box 168
Kingston Ontario K7L 5T3
Effective Date:
May 1, 2015