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For 2026, CMS has made significant changes to the Social Determinants of Health (SDoH) Screening assessment. There’s a change in the scope of the assessment as well as an increase in reimbursement. In this video, we’ll discuss everything you need to know so that you can properly code and bill for this service.
If you’d like a reference guide for the Social Determinants of Health CPT code that we’ll cover in this video, make sure to download a reference guide.
Keep in mind that the codes are based on national averages, which may vary in your area. For the exact current rate based on your location, visit the Physician Fee Schedule website.
2026 Social Determinants of Health Updates
In previous years, the screening was used to assess unmet social needs that hinder treatment. For this year, the intention of the screening has been reframed to identify the specific risks of physical activity and nutrition that directly impact care decisions. Physical activity and nutrition are foundational to chronic conditions, like hypertension, diabetes, and obesity. This assessment must influence diagnosis or treatment and will help to create meaningful patient conversations. Be sure to document accordingly to justify the assessment as well as how it affects patient outcomes.
CPT Code G0136
The SDoH assessment is billed with code G0136. The assessment is 5 to 15 minutes in length and should cover a standardized, evidence-based assessment of physical activity and nutrition.
This is a service that can be performed in outpatient settings with the exception of discharge visits. The assessment should be administered by a certified or trained auxiliary personnel under general supervision of a provider, and can be given every 6 months.
G0136 has an increased national average reimbursement this year of $20.
If the Social Determinants of Health Assessment is performed on the same day of an Annual Wellness Visit, it is fully covered for patients under Medicare Part B. An Annual Wellness Visit is a great opportunity to administer the assessment and add additional reimbursement to AWV services.
That covers the 2026 updates for the Social Determinants of Health assessment. Reach out to us here at ThoroughCare if you’d like to learn more about how we can help you grow and scale your care management programs.
