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CMS Study Shows Slight Increase in Z Code Use

A new data highlight by the Centers for Medicare & Medicaid Services (CMS) shows a slight increase in the use of Z codes to document social determinants of health (SDOH) for Medicare fee-for-service (FFS) beneficiaries in 2019. Z codes — a subset of ICD-10-CM codes — were created with the fiscal year 2015 ICD-10-CM codes to capture SDOH, such as homelessness.

CMS previously analyzed the use of Z codes among Medicare FFS beneficiaries in 2016 and 2017. Utilization remains low; among the 33.1 million continuously enrolled Medicare FFS beneficiaries in 2019, 1.59 percent of beneficiaries had claims with Z codes compared with 1.31 percent in 2016.

The five most utilized Z codes were:

  • Z59.0 Homelessness;
  • Z63.4 Disappearance and death of family member;
  • Z60.2 Problems related to living alone;
  • Z59.3 Problems related to living in a residential institution; and
  • Z63.0 Problems in relationship with spouse or partner.

Beneficiaries dually eligible for Medicare and Medicaid were overrepresented among the top five Z codes, Further, Black beneficiaries represented 24.8 percent of those with a Z59.0 – Homelessness claim.

CMS noted a number of barriers that exist to increasing documentation of Z codes, including a lack of financial incentives because Z code claims are not generally used for payment purposes.

CMS’ Office of Minority Health recently released an infographic outlining steps to collect, report, and use Z codes, as well as guidance specific to health care administrators, coding professionals, and providers.

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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