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Billing code

G846A — Pneumococcal Conjugate (Prevnar-13)

Pneumococcal conjugate vaccine

Bill G846 for a pneumococcal conjugate vaccine; add G700 when it is the only reason for the visit.

Watch for: Check the health number; a newborn's incomplete registration or a miscopied number causes rejections.

Code

G846A

Description

Pneumococcal Conjugate (Prevnar-13)

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, 2026

Termination date

No end date

Explanation

Updated October 26, 2026

Immunization with a pneumococcal conjugate vaccine. Add G700 when the vaccine is the only reason for the visit.

What it covers

G846 is the immunization code for a pneumococcal conjugate vaccine (J54). The Schedule lists the agent only, not a product or age group.

Other vaccines without a specific code are billed as G538 (J54).

Billing rules

• Marked (+): when the immunization is the sole reason for the visit, add G700, once per patient per day however many vaccines or (+) procedures are given (J3, J54).
• G700 is not payable in hospital, and is paid at 15% of its fee for patients enrolled to a capitation-based group (J3).
• May be delegated to trained office staff, even when you aren't on site, for your own patient; the chart must name who gave it (GP62–GP63).
• Payable on the same day as a counselling service by the same physician (GP58).
• The Schedule notes an immunization may be uninsured in some circumstances and refers to section 24 of Regulation 552 under the Health Insurance Act (J54, AA1).
• FHO: a Schedule 2B core service, so for enrolled patients shadow billing is 50% of the fee (Agreement p.59 §4.3–4.4, p.89).
• FHO: childhood immunizations count toward the annual childhood immunization bonus for enrolled patients aged 30–42 months (Agreement p.65 §8.1).

Often billed with

• G700 when vaccines (alone or with other (+) procedures) are the only reason for the visit (J3, J54).
• An assessment such as A007 (intermediate assessment or well baby care) when the vaccine is given at a regular visit; G700 isn't added then, because the vaccine isn't the sole reason (A4, J3).

Common rejections

• EH2: The health card version code on the claim doesn't match OHIP's record, often because the patient has a newer card; get the current version code and resubmit.
• VH9: The health number isn't registered with the Ministry; with infant vaccines this is often a newborn whose registration isn't complete yet, or a number copied wrong.
• VJ7: OHIP received the claim more than three months after the service date, so it was rejected as stale-dated (GP9).

Related codes: G700, G538, G841, G845, G848

Source: Schedule of Benefits (July 1, 2026), Diagnostic and Therapeutic Procedures, Injections or Infusions — Immunization, page J54

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