The ministry is introducing a new diagnostic code effective October 1, 2025.

To: Physicians and Software Vendors
Category: Physician services, Billing software specifications
Written by: Claims Services Branch, Health Programs and Delivery Division
Date issued: October 1, 2025
Bulletin Number: 251001

Overview

The Ministry of Health, in partnership with Public Health Ontario, is introducing a new diagnostic code to be used when administering Respiratory Syncytial Virus (RSV) immunization or diagnosing a patient with RSV. The new diagnostic code is available effective October 1, 2025.

How to Use the New Diagnostic Code

Physicians billing ‘G538A – Other immunizing agents not listed above’ do not need to include a diagnostic code in order for the service to be eligible for payment. To assist Public Health Ontario with data collection, the ministry requests that the new diagnostic code of ‘489 – RSV Respiratory syncytial virus’ be used with the G538A fee code when RSV immunization is given or with the fee code for the assessment service when a patient is diagnosed with RSV and this is the primary reason for the visit. The 489 diagnostic code is not intended to be used with the fee code for assessment services where RSV is not the primary reason for the visit, such as a well-baby visit.

Keywords/Tags

RSV; diagnostic code; respiratory syncytial virus

Contact information

Do you have questions about this INFOBulletin? Email the Service Support Contact Centre or call 1-800-262-6524. Hours of operation: 8:00 a.m. to 5:00 p.m. Eastern Monday to Friday, except holidays.