CPTCodeCalculator
E/MAssessment2026 Compliant

CPT G0136

2026 Billing Guide

SDOH Risk Assessment

Reimbursement

$16.37

Threshold

N/A

2026 Status

Active

What is CPT Code G0136?

CPT G0136 is defined as: Administration of a standardized, evidence-based Social Determinants of Health (SDOH) risk assessment, 5-15 minutes, not more often than every 6 months.

This code is primarily used for E/M services. It falls under the category of Risk Assessment / Preventive and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.

2026 RVU Components

Relative Value Units (Non-Facility)

Standard Formula Applied

Work RVU

0.18

Physician Effort

PE (Non-Fac)

0.3

Practice Expense

Malpractice

0.01

Risk Factor

Total RVU

0.49

Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor

2026 CMS Policy Intelligence

strategic integration

G0136 is a prerequisite for high-reimbursement care coordination codes in 2026 (e.g., G0019/G0022 Community Health Integration, although those are advanced targets).

efficiency shield

Protected from the -2.5% productivity adjustment (Clinical risk assessment).

Administrative Framework

Place of Service

11 (Office)

Operational Requirements

Standard CMS E/M requirements apply.

Compliance Checklist

Use of a standardized tool (e.g., PRAPARE, AAFP tool).
Documentation of the specific risk factors identified (housing, food, transport).
Plan for addressing the identified social risks.

Audit Defense

tool evidence

The medical record must include the completed tool or a detailed summary of its results.

follow up links

Show how the SDOH results informed the overall care plan or care management goals.

Common Clinical Scenarios

No clinical examples provided.

Target Specialties & Utilization

Primary CareSocial WorkIntegrated Care Teams

Typical Clinical Indications (ICD-10)

Z59.0 (Homelessness)Z55.0 (Illiteracy and low-level literacy)Z59.4 (Lack of adequate food and safe drinking water)

Frequently Asked Questions

Maximize Revenue with AI Confidence

Stop leaving earned revenue on the table. CPT Copilot (Coming Soon) automatically handles the complexity of 2026 CMS policies, identifying every opportunity while ensuring 100% compliance.