MedicaidBilling CodesMedium impact
25-1168m Integrating Social Determinants of Health Into Clinical Practice
Health Net·CA·Reimbursement
We identified it
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.
Action Required
Immediately: Billing team must update system to allow billing of HCPCS code G0136 for SDOH risk assessments during AWVs, behavioral health visits, and E&M services. Providers must document screening tool used, information source, clear health impact linkage, and use ICD-10-CM Z codes Z55-Z65 as secondary diagnoses. Update encounter forms to include SDOH screening reminders and ensure EMR has designated SDOH fields configured.