Can Nurse Practitioners Bill? Are Changes Ahead in 2026?
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
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 changing.
Stay up to date with the latest evidence and practice-changing updates .
👉Sign up for the FREE NP Reasoning newsletter.
Can NPs Bill in 2026? Big Picture
What the Canada Health Act now requires
As of April 1, 2026, medically necessary services provided by NPs must be publicly funded if those same services would be insured when provided by a physician. 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).
Patients cannot be charged for these services
Any charges are considered:
extra-billing or user fees
subject to federal funding penalties (Canada Health Transfer deductions)
In plain terms: If an NP is doing “physician-equivalent” care, provinces must pay for it, not the patient.
Historically, nurse practitioners (NPs) in provinces and territories in Canada could bill the government for medically necessary health care services, forcing some private clinic NPs to charge patients for these services.
The former Minister of Health Mark 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.
As of April 1, 2026, medically necessary services provided by nurse practitioners (NPs) must be insured under provincial and territorial health plans, prohibiting extra-billing for these services.
Beginning in December 2028, the federal government will publicly report on patient charges and may impose financial penalties for non-compliance, including deductions from the Canada Health Transfer.
This change requires provinces and territories to determine how NPs will be remunerated for insured, medically necessary care — though the specific funding models and implementation details remain unclear in certain provinces.
The issue is, the rule is clear, but how this change will be implemented across provinces is not.
Let’s break down updates out of Ontario, British Columbia, Saskatchewan, and Newfoundland.
As of April 1, 2026, medically necessary services provided by nurse practitioners are required to be covered under provincial and territorial health plans. However, since formal funding models are not yet fully implemented in all provinces, penalties for non-compliance will not take effect until April 2027.
NP Billing in Ontario - 2026 Update
Ontario is expected to miss the April 1 federal deadline to implement public funding for all medically necessary nurse practitioner services. As a result, some patients may continue to pay out of pocket for primary care provided by NPs (6).
The federal government recently clarified that services provided by nurse practitioners, when equivalent to physician care, fall under the Canada Health Act and should be publicly funded. Provinces were given a deadline to comply, but Ontario has not yet implemented a funding model.
Importantly, financial penalties for non-compliance will not begin until April 2027, creating a window for delayed implementation.
What this Means for NP Billing
Nurse practitioners in Ontario still cannot independently bill OHIP in most settings
Most NPs continue to be paid through salary-based or organization-based funding models
Some NP-led clinics, particularly private or subscription-based models, may charge patients directly due to lack of public funding pathways
There is currently no standardized, province-wide billing framework comparable to physician fee-for-service models
Why This Matters
Despite full scope of practice, including diagnosing, prescribing, and ordering tests, funding limitations continue to impact how NPs deliver care.
Key challenges include:
Limited access to publicly funded NP roles in primary care
Growth of private-pay NP clinics to meet unmet demand
Ongoing recruitment and retention challenges in publicly funded settings
Lack of flexible funding models such as fee-for-service or rostering
There is increasing pressure from stakeholders to introduce sustainable and flexible funding mechanisms, which would allow NPs to practice more independently while improving access to care, particularly in underserved communities.
Bottom Line: Ontario’s delay highlights a critical gap between NP scope of practice and funding structures. Until a formal billing or funding model is introduced, variability in how NP services are funded and accessed will persist.
NP Billing in Newfoundland - 2026 Update
Newfoundland is moving moving to publicly fund NP services, and has taken a more proactive approach to aligning with the Canada Health Act requirements (7).
A pilot program introduced in 2025 allowed a subset of nurse practitioners to be publicly funded, eliminating out-of-pocket costs for patients accessing their care. As of April 1, 2026, the province has committed to making this model permanent (7).
Under this approach:
Full-time nurse practitioners who opt into the model can provide publicly funded care without charging patients
The model is voluntary, and not all NPs have enrolled
The province is continuing to engage NPs to expand participation
What this Means for NP Billing
Newfoundland is moving toward a public funding model for NP-delivered primary care
This aligns with federal requirements that physician-equivalent services must not involve patient charges
Variability remains, as not all NPs are currently participating in the model
This approach positions Newfoundland as an early adopter in responding to federal enforcement of the Canada Health Act. By transitioning to a publicly funded NP model, the province aims to:
Reduce patient out-of-pocket costs
Protect federal transfer payments
Expand access to primary care
Bottom Line: the voluntary nature of the model means that full system alignment is still in progress.
NP Billing in British Columbia - 2026 Update
In B.C. there is No clear guidance on how specific NP billing implementation. Focus has been on regulatory overhaul (HPOA), not billing.
Interpretation:
BC is likely compliant in principle (NPs are already publicly funded in teams)
But there has been no explicit NP fee-for-service expansion announced
NP Billing in Saskatchewan - 2026 Update
There as been no mainstream coverage on Canada Health Aact compliance for NP billing
Historically:
NPs are salary-based in public system
Limited private NP clinic presence
Interpretation:
Already compliant structurally
No urgent policy shift needed
Understanding Current Funding Structures in Primary Care
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 might be billing in a similar fashion.
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 and other forms of rumuneration for nurse practitioners will come with a learning curve for everyone involved.
Final Thoughts
Let’s face it, Canada’s health care system continues to face significant strain. From overcrowded emergency departments to ongoing gaps in access to primary care, the need for scalable solutions is clear. Nurse practitioners are well positioned to help bridge this gap.
As of April 1, 2026, the federal direction is clear: medically necessary services provided by nurse practitioners should be publicly funded. However, across provinces including Ontario, British Columbia, and Saskatchewan, there have been no major concrete changes to NP billing frameworks to date. Newfoundland and Labrador has begun moving toward a publicly funded model, but full implementation across the country remains in progress.
What we are seeing is a transition period. Policy is evolving faster than funding models, leaving a temporary gap between what nurse practitioners are trained and authorized to do, and how they are paid to do it.
Looking ahead, refinement of NP remuneration across Canada is expected to continue. The hope is that future models will better support NP autonomy, improve access to care, and align funding with the realities of modern primary care delivery.
👉 Stay tuned for billing updates as they become available! Sign up for NP Reasoning.
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
Jones A. Ontario to blow past federal deadline to publicly fund nurse practitioners. CBC News. March 20, 2026. Available at: https://www.cbc.ca/news/canada/toronto/ontario-nurse-practitioners-9.7135820
Quinn M. N.L. working to end fees for patients seeing nurse practitioners. CBC News. 2026 Mar 16. Available from: https://www.cbc.ca/news/canada/newfoundland-labrador/nl-publicly-funded-nurse-practitioners-9.7127137