G0136
SDOH risk assessment, 5-15 min
Administration of a standardized, evidence-based social determinants of health (SDOH) risk assessment, 5 to 15 minutes, in person or via telehealth. CMS 2026 wRVU 0.18. Once per 6 months per beneficiary; pairs naturally with the AWV and with chronic care management workflows.
Billing guidance for G0136 is locked
- When to use it: the exact clinical situations that support billing G0136
- Documentation checklist: the 7 elements your note needs before submitting
- Common pitfalls: the 6 mistakes that get G0136 downcoded or denied
Payer notes
Medicare added G0136 to the PFS in 2024 and covers it twice per 12 months per beneficiary with no patient cost share when billed preventively. Medicare Advantage plans typically follow Medicare. Commercial payer coverage varies widely; many large commercial payers (UnitedHealthcare, Aetna, Cigna) reimburse G0136 but rates differ. Some state Medicaid programs cover G0136 directly; others fold SDOH screening into value-based-care quality measures. Check payer-specific Z-code requirements; some payers require at least one Z-code from Z55-Z65 to appear on the claim for G0136 to pay.