CMS has plans to reimburse physicians and others for health-related social needs, according to the 2024 proposed Medicare Physician Fee Schedule (MPFS) rule.^[1]

If the proposal is finalized, there would be reimbursement for three new services: social determinants of health (SDOH) risk assessment, community health integration (CHI) and principal illness navigation (PIN). There are compliance risks, including doing an assessment without follow-through.

“The theme is acknowledgment of reimbursement for health equity,” said Tiffany Ferguson, CEO of Phoenix Medical Management Inc. “What they did was create lists of codes and services that are all about giving support to clinics for all the other supportive care they provide.”

Martie Ross, a consulting principal at PYA, noted that practitioners are “already dealing with the social determinants of health and they would capture reimbursement.”

CMS is proposing to give HCPCS code GXXX5 permanent status on the Medicare telehealth services list for the SDOH risk assessment. Medicare would pay for the administration of a standardized evidence-based risk assessment tool that takes five to 15 minutes and may be administered every six months, Ross said at a July 26 webinar sponsored by PYA. “The assessment must be performed on the same day as an evaluation and management service,” she noted. Auxiliary personnel may do SDOH risk assessments if incident-to billing requirements are met.