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25-1168m Integrating Social Determinants of Health Into Clinical Practice
Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
CalViva Health now supports reimbursement for Social Determinants of Health (SDOH) screening and documentation using new HCPCS code G0136 for standardized risk assessments taking 5-15 minutes. Providers must use specific ICD-10-CM Z codes (Z55-Z65) to document social factors impacting health outcomes and follow a structured five-step screening approach during eligible visits.
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What to do
immediately · 3 steps
01Billing team must update system to allow billing of HCPCS code G0136 for SDOH risk assessments during AWVs, behavioral health visits, and E&M services.
02Providers must document screening tool used, information source, clear health impact linkage, and use ICD-10-CM Z codes Z55-Z65 as secondary diagnoses.
03Update encounter forms to include SDOH screening reminders and ensure EMR has designated SDOH fields configured.
Codes mentioned
G0136Z55Z56Z57Z58Z59Z59.0Z60Z61Z62Z63Z64Z65
Original notice
25-1168m Integrating Social Determinants of Health Into Clinical Practice
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
Related changes
See all Health Net changes →25-1166m Integrating Social Determinants of Health Into Clinical PracticeMediumNo effective date · Reimbursement25-1167m 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