What insurance policy changes affect HCPCS G0136?

There are 12 tracked policy changes affecting HCPCS G0136, including updates from Medicare/CMS, Cigna, Health Net. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS G0136?

Payers that have issued tracked updates for HCPCS G0136 include: Medicare/CMS, Cigna, Health Net, Medical Mutual of Ohio, Florida Blue.

How do I get notified when HCPCS G0136 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS G0136. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for HCPCS G0136?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

G0136 — Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, not more often than every 6 months: Insurance Policy Changes

G0136 Insurance Policy Changes

HCPCS G0136 is officially defined as "Administration of a standardized, evidence-based assessment of physical activity and nutrition, 5-15 minutes, not more often than every 6 months." HCPCS G0136 is referenced in 12 tracked payer policy changes from Medicare/CMS, Cigna, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS G0136 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

Guidelines for Coding a Wellness Visit and Sick Visit Occurring on the Same Day

Medical Mutual of Ohio·Identified Jun 20, 2026

Medical Mutual updated guidelines for billing both wellness visits and sick visits on the same day for Medicare Advantage patients. When treating acute problems during an annual wellness visit, providers can bill both the wellness code (G0402, G0438, or G0439) and a problem-oriented visit code (99202-99215) but must add modifier 25 to the sick visit code only.

G0136 Insurance Policy Changes

2026-04-16 - CMS Launches First Wave of HealthTech Ecosystem Tools, Fast-Tracking a Fully Digital, Patient-Centered Health System

2026-04-30 - CMS & FDA Announce RAPID Coverage Pathway to Accelerate Patient Access to Life-Changing Medical Devices

2026-02-05 - Hospitals: Submit Data for OPPS Drug Acquisition Cost Survey by March 31

Summary of Provider Newsroom U.S. commercial medical articles

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25-1166m Integrating Social Determinants of Health Into Clinical Practice

25-1168m Integrating Social Determinants of Health Into Clinical Practice

25-1167m Integrating Social Determinants of Health Into Clinical Practice

Guidelines for Coding a Wellness Visit and Sick Visit Occurring on the Same Day

Coding Newsletter - Annual Wellness Visit

2026-05-21 - Critical Access Hospitals: Download Your FY 2025 PEPPER

2026-04-23 - 2026 CMS Interoperability Standards & Prior Authorization Proposed Rule Resources