Medicare now covers an optional screening for social determinants of health (SDOH). As detailed in the 2024 Physician Fee Schedule Final Rule, this assessment can be conducted during an Annual Wellness Visit (AWV).
CPT code G0136 will provide $18.66 in reimbursement* when several requirements are met, including:
- 5-15 minutes of SDOH discussion
- A standardized, evidence-based SDOH health risk assessment
- Conducted by certified or trained auxiliary personnel under the general supervision of a provider
- Assesses a patient not more than once every six months
While not designed to be a screening, the SDOH assessment should relate to one or more known or suspected SDOH needs that may interfere with the practitioners' diagnosis or treatment of this patient.
Additionally, Medicare emphasizes the importance of following up with patients about identified SDOH barriers and working to connect patients with available resources.
When the SDOH review is conducted as part of the AWV, there is no beneficiary cost-sharing.
ThoroughCare offers everything needed for SDOH screening and billing
Care delivery organizations can use a standardized health risk assessment (HRA) to fulfill AWV service requirements while screening for SDOH.
Within our Annual Wellness Visit solution, ThoroughCare provides all the structure and features needed to guide the HRA with SDOH questions. Our platform also tracks the time and personnel requirements, making oversight and billing seamless.
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Once the evidence-based HRA is conducted, ThoroughCare enables continuous integration with the patient’s care plan. Clinicians can then follow through and track tasks and referrals to community resources.
Again, Medicare stresses the importance of acting on SDOH data to help patients address barriers to care.
ThoroughCare’s Health Risk Assessment covers SDOH screening requirements
The evidence-based health risk assessment within ThoroughCare covers all requirements to screen patient's SDOH. During an AWV, a patient will have the opportunity to complete a patient health questionnaire online, in office, or over the phone.
This questionnaire contains a health risk assessment. It features a health-related social needs section, which the patient may opt-in to complete. It asks about living conditions, food access, transportation, utilities, and safety. Additional questions help address unmet needs. Based on answers, the provider can support referrals to community resources.
If the patient elects to participate in this portion of the assessment, a claim for CPT code G0136 will be generated once the questionnaire is finalized. This feature within ThoroughCare helps providers address social determinants of health seamlessly, while ensuring accurate and complete documentation.
Meet SDOH assessment requirements and supplement care management services
ThoroughCare automatically connects HRA answers to the patient’s care plan. This enables the care team, clinician, or care manager to provide follow-up referrals for preventive care, as well as future health activities, services, and education.
Maximize the billing value of Annual Wellness Visits with new SDOH assessment
Social determinants and their associated barriers are frequently addressed during the AWV. With ThoroughCare, care delivery organizations can maximize AWV-related claims backed by complete documentation of the services provided.
By delivering 300 AWVs a year (see CPT codes) and assessing these same patients for SDOH every six months, healthcare organizations can generate an additional $60,177 in Medicare reimbursement.
This doesn’t include other potential reimbursement opportunities.
During the AWV, a need for additional care services, such as a follow-up exam or enrollment in a care management program, could be identified.
Forming partnerships with pharmacies can expand access to Annual Wellness Visits
Pharmacists are optimal partners for healthcare providers to deliver high-quality, continuous care. Primary care shortages and value-based contracting call for pharmacists to have an expanded role in clinical care.
Pharmacists are expected to play an “increasingly integral role in care management,” according to the Columbia University Mailman School of Public Health.
Pharmacists are well-positioned to engage patients in AWVs
- Accessibility: Ninety percent of people in the US live within five miles of a pharmacy
- Frequency: Patients interact with their pharmacist up to 12 times more frequently than their primary care provider
- Skills: Pharmacists have counseling and education skills that support AWV assessments
- Chronic illness: Pharmacists understand many aspects of chronic diseases and their interactive influences
- Drug therapy: Pharmacists are drug therapy management experts, which is crucial because most chronic illnesses require polypharmacy management
Pharmacists can also be vital to creating a profitable, sustainable, and compliant service, allowing healthcare organizations to offer assessments effectively and efficiently.
ThoroughCare simplifies Annual Wellness Visits
ThoroughCare offers end-to-end workflow for Annual Wellness Visits.
We simplify the process so providers can focus on engaging patients. Guided interviews help ask the right questions and ensure all service requirements are met. ThoroughCare includes digital solutions, such as:
- An interactive health risk assessment
- Screening tools, such as ADL, CAGE, DAST-10, GAD-7, MDQ, PAC, PHQ-2, and a mini cognitive exam
- A care gaps summary with recommended interventions
- A full report of Personalized Prevention Plan Services
- Comprehensive care planning tools
- Automated CPT code assignment for accurate billing
*Reimbursement rates are based on a national average and may vary depending on your location.
Check the Physician Fee Schedule for the latest information.
*Reimbursement rates are based on a national average and may vary depending on your location.
Check the Physician Fee Schedule for the latest information.