On July 17, CMS released the proposed rule for the Calendar Year (CY) 2026 Medicare Physician Fee Schedule (MPFS) that contains a number of updates related to social drivers of health (SDOH) and health-related social needs (HRSN) screening.
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What's Inside
Removal of SDOH Risk Assessment Billing Code: CMS is proposing to delete the SDOH Risk Assessment HCPCS Code G0136 for CY2026, citing the belief that resource costs for services under this code are already accounted for in existing codes.
HRSN Screening in New CMMI Model: As part of the mandatory Ambulatory Specialty Model (ASM), specialists in the heart failure cohort would have to provide documentation and attest to the "Connecting to Primary Care and Ensuring Completion of Health-Related Social Needs Screening" Improvement Activity.
Prevention and Management of Chronic Disease Request for Information (RFI): CMS seeks public input on services that address social isolation & loneliness, coding and payment options for medically-tailored meals, and the need for separate coding and payment mechanisms to support interventions for aging services through external partnerships.