< Billing codes

Billing code

G005A — Pregnancy Test (only insured & payable when an immediate determination of pregnancy is required)

Office pregnancy test

Bill G005 for an office pregnancy test only when an immediate answer is needed to prevent imminent physical harm to the patient.

Watch for: Without that urgent reason it isn't insured; also not payable the same day as your counselling service.

Code

G005A

Description

Pregnancy Test (only insured & payable when an immediate determination of pregnancy is required)

FHO+ basket

Covered by the FHO+ base rate payment for enrolled patients, and shadow billed at 30% (50% for Schedule 2B procedures).

Effective date

Apr 1, 2025

Termination date

No end date

Explanation

Updated October 26, 2026

Office pregnancy test, insured only when an immediate answer is needed to prevent imminent physical harm to the patient.

What it covers

G005 is a pregnancy test done in the physician's office (J67). It is a Laboratory Medicine in Physician's Office service, listed under Miscellaneous Tests (J65, J67).

The quantitative HCG test G021 is not payable for pregnancy tests; use G005 (J65).

Billing rules

• Insured only when an immediate determination of pregnancy is required to prevent imminent physical harm to the patient (J67).
• Insured only when you, or a physician substituting for you, do the test in your own office for your own patient (J65).
• The chart must record the result, your interpretation and the treatment decision based on it, or the test isn't payable (J65).
• Not marked (+) in its listing, so the G700 sole-visit premium does not apply (J67).
• May be delegated to a trained employee in your office, even when you are not on site, for your own patient; the chart must name who did it (GP62–GP63).
• For a nursing home or home for the aged patient under W010 monthly management, office lab tests by any physician that month are included in W010 (GP51).
• G005 is not on the list of services payable on the same day as counselling by the same physician (GP58).
• FHO: a Schedule 2 core (in-basket) service (Agreement p.76).

Often billed with

• An assessment of the problem that makes an urgent answer necessary; office lab tests are payable in addition to a consultation or assessment (J3).

Common rejections

• A2B: OHIP describes this as 'Service not usually performed for the patient's sex': the code didn't match the sex on the patient's OHIP record; check the health number and patient details on the claim.

Related codes: G021, G009, G010, P003

Source: Schedule of Benefits (July 1, 2026), Diagnostic and Therapeutic Procedures, Laboratory Medicine in Physician's Office — Miscellaneous Tests, page J67 (definition J65)

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