Social Needs Codes in the CO APCD Can Shed Light on Social Factors Impacting Health

CIVHC and Z codes

If a person is experiencing a situation that may impact their health or wellbeing such as housing status, domestic concerns or discrimination, their provider can choose to indicate the situation(s) by documenting one of several Z codes on their health insurance claim. CIVHC’s recent analysis of the use of Z codes in the CO APCD indicates most claims with Z codes are for children and youth, and the majority of codes fall into the “primary support group/family” category which includes one or more of the following situations:

• Absence of family member,
• Disappearance and death of family member,
• Disruption of family by separation and divorce,
• Dependent relative needing care at home,
• Stressful life events affecting family and household,
• Stress on family due to return of family member from military deployment, and
• Alcoholism and drug addiction in family.

A report published in 2021 by the Centers for Medicare & Medicaid Services (CMS) identified that, among over 33 million individuals enrolled in Medicare Fee For Service (FFS), just under 2% had claims that contained Z codes. In Colorado, the percent of people with claims that indicate a social need is similar to the national data. Since 2016, the first full year the codes were available for use by providers, use of the codes has increased, but still only a small number of Coloradans in 2022 had a claim with a Z code:

• 1% of commercially insured lives
• 4.1% of Medicaid insured lives
• 1.8% of Medicare FFS insured lives
• 2.1% of Medicare Advantage insured lives

Access & Considerations

It is important to note that a person may have more than one health-related social need identified, depending on their situation. It is also important to note that in most instances providers do not have a financial incentive or reason to include Z codes noting social factors that could impact a patient, so more people could be experiencing these issue than is reflected in the CO APCD.

To access the Excel file data with more detailed information on the types of codes being used, visit our Publications page.