As a provider in the Cigna Healthcare℠ Medicare Advantage network, you have a deep understanding of the community you serve. There are a variety of resources designed to help you address the health-related social needs of your patients and provide guidance for the documentation and coding of claims that support social determinants of health (SDOH) documented in a patient’s medical record. However, no resource can replace your judgment when caring for your patients.

SDOH risk assessments

In 2024, the Centers for Medicare & Medicaid Services implemented G0136, a code that allows reimbursement for a five- to 15-minute standardized, evidence-based SDOH risk assessment. It can be administered once every six months to assess for housing and food insecurity, transportation needs, and difficulty paying for utilities. You can use a preferred SDOH assessment tool or ask additional questions that address the specific needs of your patient population. G0136 has been permanently added to the list of reimbursable telehealth service codes.

SDOH risk assessments that you administer as part of an evaluation and management (E&M) or behavioral health visit are not considered a screening. A screening may be medically necessary as part of a comprehensive social history when you believe there are unmet SDOH needs that are interfering with your diagnosis and treatment of a condition or illness or will influence your choice of treatment or plan of care.

You may provide an SDOH risk assessment with:

• An E&M visit, which can include hospital discharge or transitional care management services.
• Behavioral health office visits, such as psychiatric diagnostic evaluation and behavioral health assessment and intervention.
• An annual wellness visit.

Z codes

International Classification of Diseases, 10th Revision, Clinical Modification, Z codes allow you to document screening results for the social needs of your patients. They refer to the socioeconomic factors that influence the health status of an individual or present themselves as a barrier to accessing clinical or medical help.

Z codes do not indicate disease or injury but are nonbillable codes that provide better understanding of the SDOH profile of the patient. They also offer insight into population management priorities.

Cultural competency and health equity resources

Visit the Cigna Healthcare Provider Education and Assessment Tools pagefor cultural competency and health equity resources that can help you and your practice better understand your patients’ diverse values, beliefs, and behaviors, and customize treatment to meet their social, cultural, and linguistic needs. These resources can be found under the Health Assessment Tools and Information section.

Learn more

Refer to the following resources to learn more about health equity:

• Advancing health equity in your practice flyer
• Striving for Health Equity for All
• Health Equity Services in the 2024 Physician Fee Schedule Final Rule
• Improving the Collection of Social Determinants of Health (SDOH) Data with ICD-10-CM Z Codes