CMS Issues Clarification on Processing SDOH Risk Assessment as Part of Annual Wellness Visit
(Sept. 13, 2024) – The Centers for Medicare & Medicaid Services clarified in the Aug. 15 MLN Matters that Medicare Administrative Contractors will process G0136 using the Physician Fee Schedule. CMS advises that hospitals, physicians and other providers billing Medicare Administrative Contractors for services provided to Medicare patients to make sure that billing staff know the following:
- A social determinants of health risk assessment is now an optional annual wellness visit element
- The eligibility and billing requirements for doing the SDOH as part of the AWV
In the CY 2024 Physician Fee Schedule final rule, CMS established HCPCS code G0136, Administration of a standardized, evidence-based SDOH risk assessment tool, 5-15 minutes, not more often than every six months. For detailed information on appropriate billing for G0136, consult the MLN Matters Number 13486.
--Karen Braman