MedicaidReimbursementMedium impact
25-1167m Integrating Social Determinants of Health Into Clinical Practice
Health Net·CA·Reimbursement
We identified it
Jun 20, 2026
Summary
New policy establishes reimbursement for Social Determinants of Health (SDOH) screening using HCPCS code G0136, which covers 5-15 minute standardized risk assessments during eligible visits. Providers must document SDOH factors using ICD-10-CM Z codes (Z55-Z65) and follow a five-step screening approach that includes screening, documentation, coding, referral, and follow-up.
Action Required
Immediately: Billing team must update system to include HCPCS code G0136 for SDOH risk assessments during AWVs, behavioral health visits, and E&M services. Train providers to use ICD-10-CM Z codes (Z55-Z65) for documenting social determinants. Update encounter forms to include SDOH screening tools like PRAPARE or AHC-HRSN. Ensure documentation includes screening tool used, information source, provider sign-off, and clear linkage to health impact for proper reimbursement.