MedicaidBilling CodesMedium impact
24-395m Use the Most Descriptive SDOH Z Codes on Claims and Encounters
Health Net·CA·Coding
We identified it
Jun 20, 2026
Summary
Health Net now requires providers to use the most specific Social Determinants of Health (SDOH) Z codes (Z55-Z65) when documenting patient circumstances on claims and encounters. For categories Z55, Z58, Z59, and Z62, providers must drill down to the most descriptive subcodes rather than using general category codes.
Action Required
Immediately: Billing team and providers must update documentation practices to use the most specific SDOH Z codes available. For Z55, Z58, Z59, and Z62 categories, drill down to subcodes (e.g., use Z59.12 for inadequate housing utilities instead of Z59.1 for inadequate housing). Update EMR templates and provider training to ensure proper code selection for documenting social determinants of health.