MedicaidBilling CodesMedium impact
22-196m Help Tailor Services and Programs for At-Risk Members with New Social Determinants of Health Codes
Health Net·CA·Prior Authorization
Effective date
Feb 3, 2022
We identified it
Jun 20, 2026
Summary
Healthcare providers in Fresno, Kings and Madera counties must now use expanded Social Determinants of Health (SDOH) ICD-10 codes on Medi-Cal claims and encounters. The DHCS priority SDOH codes have been expanded from 18 to 25 codes to better identify health disparities and support the CalAIM Population Health Management initiative.
Action Required
Immediately: Providers and billing teams must update encounter forms and EMR templates to include all 25 SDOH ICD-10 codes for Medi-Cal patients in Fresno, Kings and Madera counties. Train clinical staff to identify and document social determinants of health issues during patient encounters. Update billing software to ensure SDOH codes can be properly submitted on claims to support CalAIM Population Health Management data collection.