$2.77–$2.98
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.
On this page
CMS RVU26D · Effective 2026-10-01
G0136 SDOH assessment Medicare reimbursement rates in Maine
Reports a brief, standardized assessment of social needs such as food, housing, or transportation that may affect a patient’s health and care. Compare G0136 office and facility rates across CMS payment localities in Maine.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for G0136 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$18.82–$19.79
2 of 2 localities have a supported rate.
Facility setting
$7.76–$7.88
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Preventive services
About G0136: Standardized SDOH risk assessment
Reports a brief, standardized assessment of social needs such as food, housing, or transportation that may affect a patient’s health and care.
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.
Where the value comes from
- Work RVU0.18 · 30%
- Practice expense (office) RVU0.41 · 68%
- Malpractice RVU0.01 · 2%
174.3K
Medicare services in 2024 · #408 by national volume
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.
G0136 compared with similar codes
Office rates for Maine, from the same CMS release.
$165.66–$171.52
G0438 is the initial annual wellness visit; G0136 reports a distinct, brief SDOH assessment that may be furnished with that visit.
$130.44–$135.39
G0439 is a subsequent annual wellness visit. G0136 is the focused SDOH assessment, not the wellness visit itself.
Compare G0136 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
$18.82
Facility
$7.76
Southern Maine →
Office / nonfacility
$19.79
Facility
$7.88
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G0136 billing questions
How is G0136 different from 96160?
G0136 is specific to a standardized assessment of social determinants of health. 96160 is used for a patient-focused health risk assessment instrument that is not specifically an SDOH assessment.
Can G0136 be reported with an annual wellness visit?
Yes, when a distinct SDOH assessment is performed during the visit and its requirements are met. Document the assessment separately from the broader wellness review.
Can clinical staff administer the assessment?
Trained clinical staff may administer the instrument under appropriate clinical direction. The record should support the service and the time spent.
What time should be documented?
Document 5–15 minutes spent on the standardized SDOH assessment. The time must support the service reported.
What documentation supports G0136?
Record the standardized instrument used, the assessment time, the social risks identified, and any resulting referral or care-plan action.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
15,100G0130,,Single energy x-ray study,A,,0.21,0.96,,0.96,NA,0.02,1.19,1.19,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,3.27,3.27,0.05
15,101G0130,26,Single energy x-ray study,A,,0.21,0.11,,0.11,,0.01,0.33,0.33,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,102G0130,TC,Single energy x-ray study,A,,0.00,0.85,,0.85,NA,0.01,0.86,0.86,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,3.16,3.16,0.04
15,103G0136,,Adm of pa/n assess 5-15 m,A,,0.18,0.41,,0.05,,0.01,0.60,0.24,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,104G0137,,"Inten outpt svs,min 9 pr 7 d",X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,105G0138,,Iv cipaglucosidase alfa-atga,A,,0.21,5.62,,5.62,NA,0.05,5.88,5.88,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,106G0140,,Nav srv peer sup 60 min pr m,A,,1.00,1.60,,0.26,,0.07,2.67,1.33,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00