MedicaidDocumentationMedium impact
25-1166m Integrating Social Determinants of Health Into Clinical Practice
Health Net·CA·Reimbursement
We identified it
Jun 20, 2026
Summary
Health Net Medi-Cal now requires documentation of Social Determinants of Health (SDOH) using ICD-10-CM Z codes (Z55-Z65) and allows billing HCPCS code G0136 for standardized SDOH risk assessments during eligible visits. Providers must screen, document, and code SDOH factors that impact health outcomes to support personalized care and value-based initiatives.
Action Required
Immediately: Billing team must update encounter forms to include SDOH screening reminders for annual wellness visits, chronic care management, and behavioral health assessments. Train providers to document SDOH findings using ICD-10-CM Z codes (Z55-Z65) in problem lists and encounter notes. Configure billing system to support HCPCS code G0136 for 5-15 minute SDOH risk assessments when social barriers impact clinical decision making. Ensure clear documentation of screening tool used, information source, and health impact linkage for proper reimbursement.