MedicaidDocumentationMedium impact
24-397m Use the Most Descriptive SDOH Z Codes on Claims and Encounters
Health Net·CA·Prior Authorization
We identified it
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.
Action Required
Immediately: Providers must update documentation practices to use the most specific SDOH Z codes available rather than general category codes. Update EMR templates and billing workflows to require drill-down to subcodes for Z55, Z58, Z59, and Z62 categories. Train clinical staff to select multiple Z codes as necessary to fully document patient circumstances. This applies to all claims and encounters for Medi-Cal patients in Fresno, Kings and Madera counties.