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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

  1. 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.

  2. 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.

  3. 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

Q: What does that mean?

A: It means you can now get paid for the work associated with assessing a patient's SDOH needs 3 and developing a treatment plan accordingly, but there are some caveats, so keep reading.

Q: How do I do the SDOH assessment?

A: You must use an evidence-based, standardized tool to ask the patient about their health-related social needs. You can't just ask a few random questions about SDOH; you have to use a validated tool. CMS doesn't specify what tool to use, but they give some examples (see “Examples of SDOH assessments.") The agency's final rule also states that the assessment must include the following SDOH categories, or “domains:” food insecurity, housing insecurity, transportation needs, and utility difficulties. 2 Clinicians may choose to assess patients for other SDOH categories as well, but those four are required.

EXAMPLES OF SDOH ASSESSMENTS

SDOH assessment tools referenced in the Centers for Medicare & Medicaid Services final rule:

  • The Accountable Health Communities Health-Related Social Needs Screening Tool (Center for Medicare and Medicaid Innovation).

  • Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (National...

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