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Health NetMedicaid · Documentation · Reimbursement · CAMedium impact

25-1166m Integrating Social Determinants of Health Into Clinical Practice

Act
immediately
Effective date
Not stated in the notice
Identified
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.

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What to do

immediately · 4 steps
01Billing team must update encounter forms to include SDOH screening reminders for annual wellness visits, chronic care management, and behavioral health assessments.
02Train providers to document SDOH findings using ICD-10-CM Z codes (Z55-Z65) in problem lists and encounter notes.
03Configure billing system to support HCPCS code G0136 for 5-15 minute SDOH risk assessments when social barriers impact clinical decision making.
04Ensure clear documentation of screening tool used, information source, and health impact linkage for proper reimbursement.

Codes mentioned

G0136Z55Z56Z57Z58Z59Z60Z61Z62Z63Z64Z65Z59.0

Original notice

25-1166m 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 →
25-1168m 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

Related policy hubs

Health Net policiesCA policy changesCode G0136Code Z55Code Z56Code Z57Code Z58Code Z59Code Z60Code Z61Code Z62Code Z63Code Z64Code Z65Code Z59.0

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