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24-397m Use the Most Descriptive SDOH Z Codes on Claims and Encounters
Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
CalViva Health now requires providers to use the most specific SDOH Z codes (Z55-Z65) when documenting social determinants of health on claims and encounters. Instead of using general category codes, providers must drill down to the most descriptive subcodes available, especially for categories Z55, Z58, Z59, and Z62.
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What to do
immediately · 4 steps
01Providers must update documentation practices to use the most specific SDOH Z codes available rather than general category codes.
02Update EMR templates and billing workflows to require drill-down to subcodes for Z55, Z58, Z59, and Z62 categories.
03Train clinical staff to select multiple Z codes as necessary to fully document patient circumstances.
04This applies to all claims and encounters for Medi-Cal patients in Fresno, Kings and Madera counties.
Codes mentioned
Z55Z56Z57Z58Z59Z60Z62Z63Z64Z65Z59.12Z59.1
Original notice
24-397m Use the Most Descriptive SDOH Z Codes on Claims and Encounters
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
Related changes
See all Health Net changes →24-396m Use the Most Descriptive SDOH Z Codes on Claims and EncountersMediumNo effective date · Prior Authorization24-395m Use the Most Descriptive SDOH Z Codes on Claims and EncountersMediumNo effective date · Coding25-1166m Integrating Social Determinants of Health Into Clinical PracticeMediumNo effective date · Reimbursement25-1168m Integrating Social Determinants of Health Into Clinical PracticeMediumNo effective date · ReimbursementBrowse every Health Net change in the policy list