Utilization of Z Codes for Social Determinants of Health among Medicare Fee-for-Service Beneficiaries

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. Z codes are a tool for identifying a range of issues related – but not limited – 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. Z codes can be used in any health setting (e.g.,doctor’s office, hospital, skilled nursing facility (SNF) and by any provider (e.g., physician, nurse practitioner). There are nine broad categories of Z codes that represent various hazardous social, economic, and environmental conditions, each with several sub-codes. This data highlight provides an update to the past-published data highlight focused on Z code claims for Medicare fee-for-service (FFS) beneficiaries in 2017 . The study objectives are as follows: (1) Describe the number of total Z code claims and the proportion of continuously enrolled beneficiaries with Z code claims in 2016, 2017, 2018, and 2019.(2) Report the top five most utilized Z codes in 2019.(3) Describe the proportions of beneficiaries with Z codes across various sociodemographic characteristics, including dual eligibility status for Medicare and Medicaid, age, sex, and race and ethnicity, as well as the proportions of beneficiaries with Z codes across urban/rural strata.(4) Characterize the top five states with the largest shares of all Z code claims as well as proportion of Z code claims by claim type, service category, and provider/supplier type.(5) Highlight potential strategies that may aid in increasing utilization of Z codes representing key social, environmental, and economic risks to health.