OHIP billing code for pneumonia vaccine

Updated October 26, 2026

The OHIP billing code for the pneumonia (pneumococcal) vaccine is G846A, pneumococcal conjugate, $8.80; add G700A ($8.80) when the vaccine is the only reason for the visit. All of Ontario's publicly funded pneumococcal vaccines are now conjugate vaccines (Pneu-C-15, Pneu-C-20 and Pneu-C-21).

Code	What it is	Fee	When to bill it
G846A	Immunization, pneumococcal conjugate	$8.80	Any pneumococcal conjugate vaccine, child or adult.
G700A	Basic fee-per-visit premium for (+) procedures	$8.80	The vaccine (alone or with other (+) procedures) is the only reason for the visit.
G538A	Other immunizing agents not listed above	$8.80	A pneumococcal vaccine that isn't a conjugate, such as the polysaccharide Pneu-P-23.

How to bill it

Bill G846A for each pneumococcal conjugate vaccine dose, with diagnostic code 896 (immunization).

If the vaccine was the only reason for the visit, add G700A once, even if you give more than one vaccine.

If you give it at a visit where you bill an assessment, such as a diabetic or well-baby visit, bill G846A with the assessment and no G700A.

Billing rules

Marked (+): when the vaccine is the only 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 physician or group paid mainly by capitation (J3).
When the vaccine is given at a visit where you bill an assessment, such as A007, don't add G700: the vaccine isn't the only reason for the visit (J3).
May be delegated to trained staff you employ, even when you aren't on site, for your own patient; the chart must be dated and name who gave it. Not payable when the person giving it is employed by a hospital, public health unit, long-term care home or Family Health Team (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 points to section 24 of Regulation 552 (J54, AA1). For example, immunization given only for travel outside Canada is uninsured (Reg. 552 s.24(1) para 25).
There is no Q-code replacement for G700 with this vaccine: Q590A is only for flu shots (AQ3).
FHO: G846A is on the list of in-basket services that get the 50% blended fee-for-service premium for enrolled patients from April 1, 2026 (INFOBulletin 260502). Childhood doses count toward the childhood immunization bonus (Agreement p.65 §8.1).

Diagnostic codes

896: Immunization, all types

Common rejections

D8: OHIP's description is 'Allowed with specific procedures only'. G700 is payable only with a (+) procedure, and the Ministry has said G700 is refused with D8 when it isn't on the same claim as the immunization code (J3; INFOBulletin 4544).
VH9: Health number not registered with the Ministry. With infant doses this is often a newborn whose registration isn't complete, or a number copied wrong.

Questions

What is the OHIP billing code for pneumonia vaccine?

Who gets a publicly funded pneumococcal vaccine in Ontario?

The Ministry funds three programs: routine immunization for children 6 weeks to 4 years (Pneu-C-15), routine immunization for adults 65 and older (Pneu-C-21), and a high-risk program from 6 weeks of age (Pneu-C-20 for ages 6 weeks to 64). Pneumovax 23 (Pneu-P-23) is no longer publicly funded (Ministry of Health pneumococcal fact sheet, August 2026).

Sources

All OHIP billing codes by service · See how APEX works · Pricing