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Health NetMedicaid · Reimbursement · Reimbursement · CAMedium impact

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

Act
immediately
Effective date
Not stated in the notice
Identified
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.

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What to do

immediately · 4 steps
01Billing team must update system to include HCPCS code G0136 for SDOH risk assessments during AWVs, behavioral health visits, and E&M services.
02Train providers to use ICD-10-CM Z codes (Z55-Z65) for documenting social determinants.
03Update encounter forms to include SDOH screening tools like PRAPARE or AHC-HRSN.
04Ensure documentation includes screening tool used, information source, provider sign-off, and clear linkage to health impact for proper reimbursement.

Codes mentioned

G0136Z55Z56Z57Z58Z59Z59.0Z60Z61Z62Z63Z64Z65

Original notice

25-1167m Integrating Social Determinants of Health Into Clinical Practice
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
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Related changes

See all Health Net changes →
25-1166m Integrating Social Determinants of Health Into Clinical PracticeMediumNo effective date · Reimbursement25-1168m Integrating Social Determinants of Health Into Clinical PracticeMediumNo effective date · Reimbursement24-397m Use the Most Descriptive SDOH Z Codes on Claims and EncountersMediumNo effective date · Prior Authorization24-396m Use the Most Descriptive SDOH Z Codes on Claims and EncountersMediumNo effective date · Prior AuthorizationBrowse every Health Net change in the policy list

Related policy hubs

Health Net policiesCA policy changesCode G0136Code Z55Code Z56Code Z57Code Z58Code Z59Code Z59.0Code Z60Code Z61Code Z62Code Z63Code Z64Code Z65

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