Medicare AdvantageDocumentationMedium impact
Using ICD-10 Z codes to track social drivers of health
Harvard Pilgrim Health Care·Coding
We identified it
Jun 26, 2026
Summary
Point32Health is encouraging providers to use ICD-10 Z codes to document social drivers of health (SDOH) such as housing insecurity, food insecurity, transportation barriers, and employment issues when submitting claims. This policy aims to help identify vulnerable members and connect them to community resources, with documentation occurring during patient registration, routine exams, or condition-specific visits.
Action Required
Immediately: Billing and clinical teams must implement screening and documentation processes for social drivers of health. (1) Clinical staff: Develop SDOH screening questions to ask during patient registration and routine visits; document findings in patient records. (2) Providers: Begin including relevant Z codes (Z55, Z56, Z57, Z59, Z60, Z62, Z63, Z64, Z65, Z75) on all applicable claims submitted to Point32Health. (3) Billing team: Update claim submission procedures to ensure Z codes are captured and transmitted; train staff on proper Z code selection based on documented SDOH factors (housing, food insecurity, transportation, employment, family circumstances, etc.). (4) All staff: Reference the Social Drivers of Health Quick Reference Guide for comprehensive Z code options. Claims with properly documented and coded SDOH information will help Point32Health identify at-risk members; failure to document and code SDOH may result in missed opportunities for member outreach and resource connection.