July 24, 2025
To help track and address our members’ social needs, we encourage you to use ICD-10-CM Z codes on the claims you submit to us regarding social determinants of health. ICD-10-CM Z code data helps us better understand our members’ unique social needs.
What are social determinants of health?
SDoH refer to the economic, social and environmental conditions beyond clinical care that may influence a person’s overall health and well-being.
How you can help:
Educate staff on the need to screen, document and code data on members’ SDoH needs.
Ask about SDoH needs. Members may not know to discuss non-medical issues with health care providers and may need to be prompted.
Document any SDoH needs and assign the appropriate ICD-10-CM code to report on claims.
Read our flyer on ICD-10-CM Z codes for more information.
Code claims completely and accurately. Documentation of services should accurately reflect both the care provided and the coding and billing submitted. Codes may be for informational purposes only and may not be billable. Codes may not apply to certain members or benefit plans. Refer to our Clinical Payment and Coding Policies for more information on coding and billing.
This resource is for informational and educational purposes only. It isn’t intended to substitute for the independent medical judgment of a health care provider and is not a definitive source for coding claims. It isn’t intended to replace or supersede any requirements set forth in your contract with us. In the event of a conflict between this information and your contract or our coverage contract with your patient, your contract or our coverage contract with your patient, as applicable, will control.
Always check members’ eligibility and benefits before providing services. The fact that a service or treatment is described in this material, is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Call the number on the member ID card if you have questions.
To stay informed about upcoming SDoH resources or events, please email Yvette Davis with your name, location, and contact information.
The information provided does not constitute coding or legal advice.