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Study Reviews Use of Z Codes for Social Determinants of Health

A study by the Centers for Medicare & Medicaid Services (CMS) provides insight into the limited documentation of social determinants of health (SDOH) for Medicare fee-for-service (FFS) beneficiaries.

CMS notes a growing awareness of the importance of SDOH in patient health outcomes and that data collection using SDOH screening tools occurs across care settings. However, there are challenges to consistent data collection, including a lack of standardized electronic health record–based screening tools and inconsistent use of codes.

Z codes — a subset of ICD-10-CM codes — present an opportunity to capture social determinants, such as homelessness. Z codes did not exist before the ICD-10-CM codes were released in 2015.

CMS analyzed the use of Z codes in 2016 and 2017 among Medicare FFS beneficiaries and found:

  • 1.4 percent of total Medicare FFS beneficiaries had claims with Z codes;
  • homelessness was the most-used Z code;
  • significant disparities were observed in the use of the homelessness Z code among black, Hispanic, and American Indian/Alaska Native people;
  • 72 percent and 53 percent of beneficiaries with Z code claims had hypertension and depression, respectively; and
  • 25 percent of beneficiaries with Z code claims were dually eligible for Medicaid and Medicare.

Consistent documentation of SDOH is needed to more comprehensively identify social needs and monitor progress in mitigating them.

Learn how essential hospitals are moving outside the clinical care setting to target SDOH, at

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Maryellen Guinan is a principal policy analyst at America's Essential Hospitals.

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