The code isn't for SDOH “screening” but “assessment.” Here's what that means, and what else you need to know.
Fam Pract Manag. 2024;31(5):8-11
Author disclosure: no relevant financial relationships.
The Centers for Medicare & Medicaid Services (CMS) approved a new code earlier this year related to patients' social determinants of health (SDOH).1 HCPCS code G0136 is designed to pay clinicians for the time it takes to assess a patient's SDOH, which the care team may then address either directly or through referral.2 As with many things in life, the implementation of G0136 has differed somewhat from the intent, but here's what we know so far about how to use the new code.
KEY POINTS
HCPCS code G0136 allows clinicians to bill Medicare for performing a validated assessment of social needs that may interfere with the clinician's diagnosis or treatment of the patient.
The code, valued at 0.18 work RVUs, is not intended for SDOH screening but for assessing a patient's known or suspected social needs.
While payment for SDOH assessment has been long-awaited, the new code may have limited use given its narrow definition.
FREQUENTLY ASKED QUESTIONS
Q: What is the code?
A: HCPCS code G0136 is for “Administration of a standardized, evidence-based SDOH assessment, 5–15 minutes, not more often than every six months.”1
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