Physician's Guide - Billing for medical reports
You must send an original invoice to CPP for your services. Faxed and photocopied invoices are not acceptable.
When the total payment for your services in a calendar year exceeds $500, the Income Tax Act requires the Department to complete a "Government Service Contract Payments" form (T1204) for the Canada Revenue Agency.
Depending on your practice/business, the invoice must include one of the following:
Individual or unincorporated practice/business
- the physician's social insurance number (SIN),
- the business (BN), or
- the goods and services tax (GST) / harmonized sales tax (HST) number.
Partnership
- the practice/business number,
- the GST/HST number,
- the partnership filer identification number; or
- the individual partners' social insurance numbers.
Corporation
- the practice/business number from the Canada Revenue Agency (CRA).
Upon receipt of a completed report and original invoice, CPP will reimburse you:
- up to $65 for the initial "Medical Report" or the "Declaration of Incapacity – Physician's Report";
- up to $25 for the "Reassessment Medical Report" or the "Medical Report – Recurrence of the Same Medical Problem"; and
- up to $50 for the "Impairment Evaluation".
CPP may ask you to provide other information in the form of a narrative report, and will pay up to $150 for it, based on its complexity and the time required to complete it.
Your patient is responsible for covering any extra costs. If your fees are higher than these amounts, please bill your patients directly.
Fees mentioned in this section are set in consultation with the Canadian Medical Association and are subject to change.
Occasionally, CPP may ask your patient to attend an independent medical examination or functional capacity evaluation during the application process, or when determining continuing eligibility. CPP pays the specialist physician or facility directly for these examinations.
Release of information under the Canada Pension Plan legislation
Your patient has the right to see and to receive a copy of all the information on his or her CPP file, including the medical report that you fill out and any supporting documents you include. Please indicate in your report if you feel it would be detrimental to your patient to be given particular information about his or her medical condition. CPP will contact you directly to determine whether the patient's condition has changed and whether this information can be withheld under section 25 of the Privacy Act, which states that "personal information can be withheld if the disclosure of information may threaten the safety of an individual."