New Data Highlight on Z Codes Now Available

The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) released a new data highlight: Utilization of Z Codes for Social Determinants of Health among Medicare Fee-for-Service Beneficiaries, 2019.

Z codes are a set of ICD-10-CM codes used to report social, economic, and environmental determinants known to affect health and health-related outcomes. Nine broad categories of Z codes represent various hazardous social, economic, and environmental conditions. Z codes can be used in any health setting and by any provider as a tool for identifying a range of issues related to education and literacy, employment, housing, ability to obtain adequate amounts of food or safe drinking water, and occupational exposure to toxic agents, dust, or radiation.

The data highlight found that among the 33.1 million continuously enrolled Medicare fee-for-service (FFS) beneficiaries in 2019, 1.59% had claims with Z codes, an increase as compared to 1.31% in 2016.

Findings include:

  • The 5 most-utilized Z codes included those for homelessness, disappearance and death of family member, problems related to living alone, problems related to living in a residential institution, and problems in relationship with spouse or partner.
  • Beneficiaries who are dually eligible for Medicare and full-benefit Medicaid were overrepresented among the top 5 Z code claims.
  • Beneficiaries in rural areas were overrepresented (39.7%) among those coded as having problems related to living in a residential institution claim.
  • Male beneficiaries who accounted for 45.4% of the overall FFS population represented 67.1% of those with a homelessness claim.
  • Black and Hispanic beneficiaries accounted for 8.8% and 5.9% of the overall FFS population, respectively, but represented 24.8% and 9.2%, respectively, of those with a homelessness claim.
  • The top 5 provider types representing the largest proportions of those assigning Z codes to claims were family practice physicians, internal medicine physicians, nurse practitioners, psychiatry physicians, and licensed clinical social workers.

Using social determinants of health Z codes can enhance quality improvement activities, track factors that influence people’s health, and provide further insight into existing health inequities.

Looking for more information on Z Codes? Review the guide Using Z Codes: The Social Determinants of Health (SDOH) Data Journey to Better Outcomes, which provides step-by-step instructions for healthcare professionals on how to use Z codes.

For more CMS OMH health equity-focused resources, visit: