Revision to social determinants of health risk assessment (HCPCS code G0136)

CMS recently revised the code descriptor for HCPCS code G0136 to remove the Social Determinants of Health Risk (SDOH) assessment, which now reads “Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, not more often than every 6 months.” HCPCS code G0136 will remain on the Medicare Telehealth Services List.

Per the CMS Final Rule CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies (CMS-1832-F), HCPCS code G0136 is payable when both physical activity and nutrition risk assessment are performed, or when either a physical activity or risk assessment is performed if there is a clinical scenario where only one is reasonable and necessary. For example, if a beneficiary has recently started a new diet but their physical activity levels have not been assessed, only a physical activity risk assessment may be reasonable and necessary.

CMS expects the practitioner furnishing HCPCS code G0136 would, at a minimum, refer the patient to relevant resources and consider the results of the assessment in their medical decision-making, or diagnosis and treatment plan for the visit. Physical activity and nutrition risk assessment, through a standardized, evidence-based tool, can more effectively and consistently identify unmet physical activity and/or nutrition needs and enable comparisons across populations. The administration of a standardized, evidence-based physical activity or nutrition risk assessment tool must be tested and validated through research. 

Examples of evidence-based tools to assess nutrition include, but are not limited to, the Mini-EAT tool, the Starting the Conversation: Diet tool, and Short Dietary Assessment Instruments. Examples of evidence-based tools to assess physical activity include, but are not limited to, the Physical Activity Vital Sign tool, the CHAMPS Physical Activity Questionnaire for Older Adults, and the Rapid Assessment of Physical Activity (RAPA) or Telephone Assessment of Physical Activity (TAPA). 

All billing rules for HCPCS code G0136 will remain the same, including, in addition to an outpatient E/M visit (other than a level 1 visit by clinical staff), HCPCS code G0136 can also be furnished with CPT code 90791 (Psychiatric diagnostic evaluation) and the Health Behavior Assessment and Intervention (HBAI) services, described by CPT codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168.

Reference

• CMS Final Rule CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies (CMS-1832-F)