HCPCS code G0136: SDOH assessment, 5–15 minutes2026 Medicare rate & RVUs

Medicare pays $20.04 for G0136 nationally in the office and $8.02 in a hospital or facility. Local office rates run $17.95–$26.60.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What G0136 covers

G0136 represents a focused, standardized assessment of social risks that may interfere with health or treatment. A physician or other qualified health professional may conduct it, or trained clinical staff may administer the instrument under appropriate clinical direction. Questions may address food access, housing stability, transportation, utilities, or interpersonal safety. It is used in office and other eligible outpatient encounters to identify needs that may call for referrals or changes to the care plan; it is not social-service navigation itself.

Report the code when the documented assessment takes 5–15 minutes and uses a standardized, evidence-based instrument. The record should identify the instrument, time spent, relevant responses or risks, and any resulting follow-up plan. G0136 may be reported in connection with an annual wellness visit or an evaluation and management service when the SDOH assessment is performed as a distinct service. CMS assigns physician fee schedule work and practice-expense values to the service.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where G0136 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

G0136 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the G0136 rate is calculated

Each of G0136’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for G0136

G0136 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

G0136 compared with similar codes

How to choose

96160Health risk assessmentPatient-focused instrument

Use G0136 for an assessment focused on social determinants of health. Use 96160 for a patient-focused health risk assessment instrument addressing health risks more broadly.

G0438Annual wellness visitInitial visit, first AWV

G0438 is the initial annual wellness visit; G0136 reports a distinct, brief SDOH assessment that may be furnished with that visit.

G0439Annual wellness visitSubsequent visit

G0439 is a subsequent annual wellness visit. G0136 is the focused SDOH assessment, not the wellness visit itself.

Codes related to G0136

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates