Can Nurse Practitioners Bill? Big Changes Ahead in 2026
Currently, nurse practitioners (NPs) in provinces and territories in Canada cannot bill (or charge) for health care services, and instead have mainly been salaried.
Why do NPs have billing numbers?
While NPs are issued a a billing number, it is only used for administrative purposes, such as facilitating referrals to physicians for consultations or procedures. Nurse Practitioners cannot bill OHIP directly on a fee-for-service basis (for things like assessment, diagnosis, and treatment) (1,2).
NP Billing in Canada: Current State in 2025
Nurse practitioners have been opening up independent practices (e.g. private NP clinics) all over the country to provide medically necessary services for patients. These NPs operating independently can charge patients a fee for the services they provide. However, unlike physicians, there are currently no formal remuneration systems or billing models for self-employed NPs.
That said, charging clients may not be suitable in every practice setting. Nurse practitioners establishing their own fee structures are expected to follow regulatory body guidance, ensure transparency and fairness, and avoid any practices that could be considered unprofessional or misleading (2).
For years, many nurse practitioners (NPs) across Canada have found themselves in a difficult position — providing medically necessary care that patients had to pay for out of pocket because NPs could not bill the government for their services. That’s about to change.
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Can NPs Bill in 2026?
According to a 2025 CBC article, federal Health Minister Mark Holland announced that, starting April 1, 2026, provincial and territorial health plans will cover primary care provided by nurse practitioners, pharmacists, and midwives. The move comes through a new interpretation of the Canada Health Act, clarifying that regulated health professionals who aren’t physicians will be able to bill for medically necessary services that would otherwise be covered if performed by a doctor (3).
Holland said charging patients for essential NP care is “not consistent with universal health care,” and this policy will ensure all Canadians can access needed services regardless of who provides them (3). This is a result of years of advocacy work by the Nurse Practitioner Association of Ontario.
The change will be enforced through federal health transfer payments, ensuring provinces comply. Once implemented, it’s expected to expand access to primary care, reduce pressure on physicians, and recognize the full scope of practice that nurse practitioners bring to the health system.
How will NPs Bill?
This is still up in the air - to ensure a smooth transition, provinces will be required to define the fee structure for NP-delivered services. This may lead to variations in billing procedures and compensation models across the country, as provinces decide on the best approach for their unique healthcare systems.
NPs working independently (e.g. running and operating their own clinics) must navigate the complexities of billing provincial health plans—a challenge many clinics and physicians already struggle with. Billing involves strict documentation and compliance requirements, which can be overwhelming at first. Historically, we haven’t learned how to bill in NP school! Independently run clinics will need to train staff and potentially invest in systems to support billing for NPs.
Overall, things are still up in the air for NPs and billing - but I think it’s important we understand current billing practices, as NPs will likely be billing in a similar fashion as physicians.
Primary Care Models and Billing
There are several primary care billing practices that currently exist for physicians, which is structured around different primary care models. Here are some examples in Ontario (4,5):
Fee-for-Service (FFS) / Conventional Practice
Providers bill for each individual service rendered.
Roster-based or non-roster-based models may apply.
Pros: strong linkage between service provided and payment; flexible for providers.
Cons: income depends on volume; may discourage time-intensive care or non-billable tasks.
Comprehensive Care / Capitation-Blended Models
Providers receive a base payment or “capitation” for enrolled patients, sometimes blended with fee-for-service components.
There may also be bonuses, premiums, and incentives (e.g. for chronic disease management, access targets).
Encourages continuity, prevention, and proactive care rather than episodic visits.
Group / Team-Based Practices (e.g., Family Health Teams, Interprofessional Teams)
Multiple health professionals (physicians, nurse practitioners, nurses, pharmacists, etc.) collaborate.
Funding may include salary, block funding, or blended models.
Goal: deliver broader services (health promotion, care coordination) and share burdens.
Community-Governed / Non-Profit Models (e.g., Community Health Centres, Indigenous Health Access Centres)
Focus on underserved populations or communities with specific needs.
Salaried providers, with mission-driven goals, often with wraparound social services.
Less reliance on fee-for-service; more emphasis on accessibility, equity, and population health.
Independent / Solo Practice
One provider operating independently with or without team affiliation.
May rely fully on FFS or limited blended payments.
Offers autonomy but carries more financial and operational risk.
With primary care models and billing structures varying not only across Ontario but throughout Canada, the shift to new billing structures for nurse practitioners will come with a learning curve for everyone involved.
Let’s face it - Canadians are facing significant challenges when it comes to our healthcare system – from overwhelmed emergency rooms, to lack of access to a primary care provider - we need Nurse Practitioners to help alleviate this strain. Allowing NPs to bill for medically necessary health care services will help patients gain access to the right care in the right place at the right time.
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References
Nurse Practitioner Association of Ontario. Funding, Hiring and Compensation for Nurse Practitioners. Available from https://npao.org/npao-faqs/
College of Nurses of Ontario. Fees. Available from https://www.cno.org/standards-learning/ask-practice/fees#fees-can-nurses-charge-a-fee-for-the-nursing-services-they-provide-in-independent-practice
CBC News. Public health plans to cover primary care by nurse practitioners and midwives in 2026. 2025. Available from https://www.cbc.ca/news/politics/provincial-health-plans-nurse-practitioners-1.7428343
Ontario Medical Association. Primary Care Models. Available from https://www.oma.org/practice-professional-support/starting-your-practice/primary-care-models/
Government of Ontario. Primary care payment models in Ontario. Available from https://www.ontario.ca/page/primary-care-payment-models-ontario