This is information from the 2024 Physician Fee Schedule PROPOSED Rule
CMS is proposing to establish a standalone G-code (HCPCS) for the assessment of SDoH. They define SDoH into broad groups: “economic stability, education access and quality, neighborhood and built environment, and social and community context, which include factors like how soon, food and nutrition access, and transportation needs.” p. 251-252. CodingIntel addressed the question of what conditions are included in SDoH in a recent Q&A.
CMS hasn’t released the proposed code but the placeholder code, GXXX5, is defined as administration of a standardized evidence-based social determinants of health risk assessment, 5-15 minutes, not more often than every six months. The risk assessment is in relation to the patient’s social risk factors that influence the diagnosis and treatment of medical conditions. This assessment must be done on the day of and E/M service. CMS identified these tools as evidence-based tools that would meet the requirements, although other tools would be allowed. CMS Accountable Health Communities tool, the Protocol for Responding to & Assessing Patients’ Assets, Risks and Experiences, (PRAPARE) tool, Instruments identified for Medicare Advantage Special Needs Population Health Risk Assessments. The code would have wRVU of .18.
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