Glossary of Common Healthcare Abbreviations

A standardized Medicare notice given before a service when Medicare is likely to deny payment, informing the beneficiary of potential financial liability and allowing them to decide whether to proceed. Learn more.

A nonprofit medical association that awards credentials to cardiovascular specialists who meet the qualifications. Learn more.

A CMS value-based care model launched in 2023. It replaced the Direct Contracting Model (DCM) and requires participating organizations to take on financial risk while advancing health equity through population-based payment and quality measures. Learn more.

The cost-based payment rate used by Medicare to reimburse Rural Health Clinics (RHCs) for each qualifying patient encounter. The AIR includes both professional and facility services, is calculated through the Medicare Cost Report, and is capped annually by CMS to ensure equitable reimbursement across rural providers. Learn more.

A CMS payment approach that ties reimbursement to quality and cost outcomes instead of service volume. Examples include Accountable Care Organizations (ACOs), bundled payments, and primary care initiatives. Providers in qualifying Advanced APMs may earn a 5% Medicare incentive and be exempt from MIPS reporting. Learn more. 

A screening tool that measures the ratio of a patient’s height to their weight to estimate body fat percentage.

A rural acute-care hospital designated by CMS to preserve essential healthcare services in geographically isolated communities. CAHs receive cost-based Medicare reimbursement and must meet strict requirements for rural location, 25-bed limits, emergency readiness, length of stay, swing-bed utilization, and Conditions of Participation. Learn more.

Standardized codes used in healthcare billing to explain why claims are adjusted, reduced, or denied. Appearing on Explanations of Benefits (EOBs) and Electronic Remittance Advices (ERAs), CARC codes support denial management, compliance, and revenue cycle optimization.  Learn more.

A  geographic region where Medicare’s Competitive Bidding Program applies to certain DMEPOS items. Beneficiaries who live in a CBA generally must use contract suppliers and are reimbursed under Single Payment Amount rates for competitively bid products. Learn more.

A Medicare payment and supplier selection system for certain DMEPOS items. CMS uses supplier bids to set Single Payment Amounts and limits billing in Competitive Bidding Areas to contract suppliers to control costs and protect program integrity. Learn more. 

A standardized electronic patient summary built on HL7’s Clinical Document Architecture (CDA). It includes demographics, clinical data, medications, allergies, and care plans to support interoperability, care transitions, and CMS reporting requirements.  Learn more.

A healthcare data standard created by HL7 for structuring and exchanging electronic clinical documents such as discharge summaries, consultation notes, and care plans. It uses standardized vocabularies like SNOMED CT, LOINC, and UCUM to ensure consistent data across EHR systems. While not a billing standard, C-CDA supports care coordination, regulatory compliance, and quality reporting, and remains widely used alongside newer standards like FHIR. Learn more.

A standardized framework for documenting and sharing patient care coordination information. It captures demographics, clinical data, care team details, social determinants of health (SDOH), and care plans to improve interoperability, support value-based care, and meet CMS reporting requirements.  Learn more.

A CMS-administered program that measures the accuracy of Medicare Fee-for-Service payments by reviewing statistically selected claims. Managed under the Payment Integrity Information Act, CERT identifies overpayments, underpayments, and documentation errors to calculate the national improper payment rate. Its findings help CMS improve payment accuracy, strengthen program integrity, and promote equitable, data-driven oversight across the Medicare system. Learn more. 

The dollar multiplier used by CMS to convert Relative Value Units (RVUs) into final payment amounts under the Medicare Physician Fee Schedule. Updated annually, it reflects inflation, budget neutrality, and policy adjustments that determine nationwide physician reimbursement rates. Learn more.

Healthcare services integrated within community settings to enhance access, improve health outcomes, and address social determinants of health (SDOH) by linking individuals with local resources and support. Learn more.

A CMS enrollment event triggered when the legal ownership or controlling interest of a healthcare provider changes, requiring reporting through PECOS or a Medicare Administrative Contractor to transfer billing privileges and the Medicare provider agreement correctly. Learn more.

A community-based public health professional who provides culturally aligned health education, care navigation, and social needs support. CHWs help patients access services, manage chronic conditions, and reduce barriers to care, especially in underserved populations. Learn more.

A CMS-enforcement fine issued to nursing homes for survey-identified noncompliance, with penalty amounts based on scope, severity, and duration of resident risk. Learn more.

CMS is the federal agency that administers Medicare and oversees key aspects of Medicaid and other federal health programs. CMS sets policies for reimbursement, quality reporting, and compliance across the healthcare system. Learn more.

Works under the supervision of a licensed nurse to aid patients with tasks such as daily living activities and mobility. Learn more.

The insurance process that determines which health plan pays first when a patient has multiple coverages. The primary insurer pays first, while the secondary insurer may cover remaining eligible costs. Proper COB handling prevents duplicate payments, reduces denials, and ensures accurate billing. Learn more.

CMS health, safety, and operational standards that providers must meet to participate in Medicare and Medicaid and maintain reimbursement eligibility. Learn more.

A CMS advanced primary care model (2017–2021) that provided practices with care management fees, prospective payments, and performance incentives in exchange for enhanced care delivery requirements. CPC+ was designed to strengthen primary care and inform future value-based care models like Primary Care First (PCF). Learn more.

Documented public costs certified by state or local government entities as the non-federal share of Medicaid funding. Authorized under Section 1903(w) of the Social Security Act, CPEs allow states to claim federal matching funds (FMAP) for verified Medicaid expenditures. Unlike Intergovernmental Transfers (IGTs), CPEs do not involve fund transfers—relying instead on cost certification to ensure fiscal transparency, compliance, and accountability in Medicaid financing. Learn more.

Non–face-to-face, technology-enabled services provided by physicians and clinical staff to manage patient care between visits. They include Chronic Care Management (CCM), Principal Care Management (PCM), Remote Monitoring (RPM), and virtual communication codes. CTBS reimburse team-based care that supports access, coordination, and value-based care delivery. Learn more. 

Medically necessary equipment ordered by a provider to support a Medicare beneficiary’s health, mobility, safety, or functional independence in the home. Medicare reimburses DME under strict rules managed by DME MACs, including HCPCS coding, rental vs. purchase requirements, documentation standards, supplier accreditation, proof of delivery, and medical necessity criteria. Learn more.

The Medicare benefit category and payment framework that governs coverage, supplier standards, documentation requirements, and reimbursement for medically necessary home- and outpatient-based equipment and related items. Learn more.

Medicare inpatient payment categories that group hospital stays by clinical condition and expected resource use to determine a bundled reimbursement amount under the Inpatient Prospective Payment System (IPPS). Learn more.

Disproportionate Share Hospital Payments are supplemental Medicaid reimbursements made to hospitals that treat a high volume of low-income and uninsured patients. Authorized under Section 1923 of the Social Security Act, DSH payments help offset uncompensated-care costs and sustain safety-net providers. States determine eligibility and payment formulas through CMS-approved State Plan Amendments to ensure compliance with federal funding limits. Learn more.

The standardized digital system used to exchange administrative and financial healthcare data between providers, clearinghouses, and Medicare Administrative Contractors (MACs). EDI enables HIPAA-compliant transactions such as 837 electronic claims, 835 Electronic Remittance Advice, eligibility inquiries, and claim status updates. It improves billing efficiency, reduces errors, and supports consistent Medicare adjudication and reimbursement processes. Learn more.

A required Medicaid benefit for individuals under age 21 that covers preventive screenings, diagnostic services, and medically necessary treatment to correct or improve physical, behavioral, developmental, or dental conditions. Learn more.

A statement issued by a health insurance payer after processing a claim. It outlines the services billed, the allowed amount, insurer payments, and the patient’s financial responsibility. EOBs help providers reconcile claims, track denials, and manage revenue cycle operations.  Learn more.

A CMS value-based care program launched in 2023 to improve quality and coordination of cancer treatment while lowering costs. It replaced the Oncology Care Model (OCM) and focuses on 6-month episodes of care for patients receiving chemotherapy for seven common cancer types. EOM provides oncology practices with monthly Enhanced Oncology Services (EOS) payments, requires equity-focused care delivery, and holds participants accountable for cost and quality performance. Learn more.

The electronic version of an Explanation of Benefits (EOB), transmitted in the HIPAA 835 format. It details how claims are paid, adjusted, or denied, including CARC and RARC codes. ERA/835 files support payment posting, denial management, compliance, and automation in the healthcare revenue cycle.  Learn more.

The portion of Medicaid costs reimbursed by the federal government to states for eligible services and administrative activities. FFP is based on defined federal match rates and plays a central role in how Medicaid programs are funded, administered, and sustained. Learn more.

A healthcare data standard created by HL7 to enable secure, web-based exchange of electronic health information. It organizes data into modular “resources” such as Patient, Observation, and Claim, which can be shared through APIs using formats like JSON or XML. FHIR integrates with coding systems including SNOMED CT, LOINC, and UCUM, and underpins federal interoperability rules in the United States. By improving data sharing, FHIR supports patient access, care coordination, quality reporting, and value-based care. Learn more.

The statutory rate that determines the federal share of each state’s Medicaid spending. It is calculated annually based on state per-capita income and governs how Medicaid costs are split between the federal government and states. Learn more.

Practices that result in improper use of healthcare funds or resources. Fraud involves intentional deception, while waste and abuse typically involve unnecessary cost or improper billing or clinical practices that do not meet accepted standards. Learn more.

The composite regional adjustment used by CMS to modify physician reimbursement under the Medicare Physician Fee Schedule. It combines the three GPCI components—Work, Practice Expense, and Malpractice—into a single weighted factor that reflects local cost variations across Medicare payment localities.  Learn more.

Assists elderly patients with daily living activities and tracks any changes in physical and mental health status. Learn more.

A Medicare payment adjustment factor that accounts for regional cost differences in physician labor, practice expenses, and malpractice insurance. Used in the Medicare Physician Fee Schedule (MPFS), GPCI ensures reimbursement reflects local economic conditions by modifying each service’s Relative Value Units (RVUs).  Learn more.

A healthcare organization that provides skilled nursing and therapy services to patients in their homes under a physician’s plan of care. HHAs are a key part of Medicare post-acute care and must meet coverage, documentation, and reimbursement requirements.

The secure electronic sharing of patient health information between authorized providers, hospitals, payers, and other healthcare organizations to improve care coordination, safety, and outcomes. Learn more. 

A global nonprofit that develops standards for electronic health information exchange. Its frameworks — including HL7 v2, CDA, and FHIR — allow hospitals, payers, and vendors to share patient data, support interoperability, and meet value-based care requirements.  Learn more.

A federal designation assigned by HRSA to areas, population groups, or facilities with shortages of primary care, mental health, or dental providers. HPSA status determines eligibility for Medicare bonus payments, NHSC workforce incentives, and programs that improve healthcare access in underserved communities. Learn more.

A structured patient questionnaire that identifies clinical, behavioral, functional, and social risks to support preventive care, risk stratification, and personalized care planning. Learn more.

A coordinated group of healthcare professionals from different disciplines who collaborate to plan, deliver, and evaluate patient care, particularly in Medicare-regulated and post-acute settings. Learn more.

Financial transfers between government entities—such as local public hospitals or health agencies—and state Medicaid programs. Authorized under Section 1903(w) of the Social Security Act, IGTs fund the non-federal share of Medicaid payments, allowing states to draw federal matching funds for supplemental programs like DSH and UPL. All IGTs must originate from public, non-federal sources and comply with CMS reporting and audit requirements. Learn more.

An IHS clinic is a primary care or outpatient facility within the Indian Health system—operated by the Indian Health Service, a Tribe under a 638 agreement, or an Urban Indian Health Program—that provides culturally grounded care to American Indian and Alaska Native communities using a mix of IHS funding and third-party reimbursement. Learn More.

A network of independent healthcare providers that contracts collectively with payers while allowing each member to retain ownership of their own practice. Learn more.

A specialized healthcare setting that provides intensive, multidisciplinary rehabilitation under physician oversight for patients recovering from serious illness, injury, or surgery. IRFs follow Medicare-specific coverage, documentation, and reimbursement requirements. Learn more.

A CMS value-based care model launched in 2022 to improve outcomes for patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The model builds on the retired Comprehensive ESRD Care (CEC) Model and expands participation to nephrology practices, dialysis facilities, and care management organizations. KCC aligns financial incentives with quality measures to encourage earlier intervention, better care coordination, and improved patient outcomes. Learn more.

Regional Medicare coverage policies issued by Medicare Administrative Contractors (MACs) that specify when a service is considered reasonable and medically necessary. LCDs outline covered and non-covered indications, documentation requirements, coding rules, and billing limitations for specific CPT and HCPCS codes. They supplement national Medicare policy, guide MAC claim adjudication, and play a central role in medical necessity determinations, audit programs, and Medicare reimbursement compliance. Learn more.

A universal standard for coding laboratory tests, clinical measurements, and health observations. Each LOINC code represents a specific type of result, ensuring consistency across electronic health records (EHRs), laboratories, and health systems. While not used for billing, LOINC supports interoperability, quality reporting, population health, and value-based care by making clinical data comparable and sharable. Learn more.

An alternative to traditional Medicare in which private health plans contract with CMS to deliver Part A and Part B benefits. Plans receive capitated payments from CMS and may offer prescription drug coverage and supplemental benefits. MA supports innovation models like VBID and plays a key role in advancing value-based care. Learn more.

Regional private organizations contracted by CMS to manage Medicare operations. They process and pay claims, oversee provider enrollment, conduct audits, and apply Medicare fee schedule rules across assigned jurisdictions to ensure accurate and consistent reimbursement.  Learn more.

A private health plan that contracts with Medicare to offer Medicare Part A and Part B benefits through Medicare Advantage (MA). MAOs manage coverage, provider networks, utilization management, claims operations, quality programs, and compliance requirements. Learn more.

A rural hospital quality initiative for Critical Access Hospitals that uses a standardized core measure set and Flex Program support to drive continuous improvement in care quality, safety, and patient experience. Learn more.

The complexity of clinical judgment used by providers to diagnose, assess, and manage patient care. It is a foundational component in selecting CPT codes for Evaluation and Management (E/M) billing and reimbursement. Learn more.

The CMS-required standardized resident assessment tool used in nursing homes to document clinical and functional status, guide RAI-based care planning, support quality monitoring, and determine Medicare SNF reimbursement classification. Learn more.

A measurement of inflation in physician practice costs and is used by CMS to adjust Medicare reimbursement rates. It tracks changes in wages, rent, supplies, and capital costs, influencing annual payment updates under the Medicare Physician Fee Schedule (MPFS) and Rural Health Clinic (RHC) All-Inclusive Rate (AIR). Learn more.

A federal program run by the Centers for Medicare & Medicaid Services (CMS) that adjusts Medicare reimbursements based on clinician performance in four categories: Quality, Improvement Activities, Promoting Interoperability, and Cost, resulting in positive, neutral, or negative payment adjustments. Learn more. 

The standardized payment system used by Medicare to reimburse physicians and qualified health professionals for covered services. Based on the Resource-Based Relative Value Scale (RBRVS), it uses RVUs, GPCI adjustments, and a Conversion Factor to calculate final payment amounts under Medicare Part B. Learn more.

Federal rules that determine when Medicare pays secondary to another insurer. Medicare is secondary when another payer is legally responsible for payment, and incorrect MSP billing can result in denials and repayment risk. Learn more.

A CMS value-based care model where groups of providers, called Accountable Care Organizations (ACOs), work together to improve quality and lower costs for Medicare beneficiaries. Successful ACOs can earn shared savings, while those in higher-risk tracks may also share in losses. Learn more.

A federal designation assigned by HRSA to geographic areas with limited primary care access based on the Index of Medical Underservice (IMU). MUAs—and Medically Underserved Populations (MUPs)—identify communities with significant socioeconomic barriers and unmet healthcare needs, guiding eligibility for FQHC funding and broader equity-focused programs. Learn more.

A CMS program that uses standardized coding edits to prevent improper billing of services that should not be reported together under Medicare. NCCI edits affect claim payment, modifier use, and compliance oversight.

Binding Medicare policies issued by the Centers for Medicare & Medicaid Services (CMS) that define whether a service, procedure, device, or diagnostic test is reasonable and necessary nationwide. NCDs establish uniform coverage criteria, documentation requirements, coding expectations, and limitations that apply across all Medicare Administrative Contractor (MAC) jurisdictions. NCDs override Local Coverage Determinations (LCDs) and are used in claim adjudication, audit programs, and medical necessity reviews to ensure consistent, evidence-based coverage for all Medicare beneficiaries. Learn more.

A unique 10- or 11-digit identifier assigned by the FDA to every drug product in the United States. Divided into three segments—labeler, product, and package—the NDC functions as a universal product number for medications. NDCs are used in drug labeling, electronic prescribing, claims processing, and the Medicaid Drug Rebate Program. While focused on product identification rather than clinical intent, NDCs play a critical role in medication safety, reimbursement, and public health monitoring. Learn more.

A unique 10-digit identification number issued by CMS to healthcare providers and organizations in the U.S. NPIs are required for all HIPAA-standard transactions, including billing and claims, and serve as a universal provider ID across payers and healthcare systems. Learn more.

The CMS-managed database that issues and maintains National Provider Identifiers (NPIs) and stores standardized provider identity and taxonomy information used across payer enrollment and claims systems. Learn more.

A standardized clinical assessment required by Medicare for Home Health Agencies. It captures patient status at key points in a home health episode and is used for care planning, reimbursement, quality measurement, and compliance oversight. Learn More.

A federal oversight agency responsible for protecting the integrity of federally funded healthcare programs. In healthcare, OIG conducts audits, investigations, and evaluations, enforces exclusions, and issues guidance that shapes compliance, billing, and program operations. Learn more.

A healthcare professional who can provide patient care while working under the supervision of a licensed physician. Learn more.

A CMS primary care payment model launched in 2021 that provides practices with population-based payments and performance incentives to improve patient care. PCF simplifies CPC+ by reducing payment streams, strengthening the link between performance and revenue, and qualifying as an Advanced Alternative Payment Model (APM) under QPP. Learn more.

Medicare’s home health payment methodology that bases reimbursement on patient characteristics, including clinical condition, functional status, admission source, and comorbidities, rather than therapy visit volume. Learn more.

A state-run electronic database that tracks prescriptions for controlled substances. PDMPs are used by prescribers and pharmacists to identify potential misuse, improve patient safety, and support compliance with prescribing laws and Promoting Interoperability (PI) requirements. Learn more.

CMS’s online platform for managing Medicare provider enrollment, ownership disclosures, practice locations, and reassignment relationships. It determines whether a provider or supplier is eligible to bill Medicare. Learn more.

A formal government declaration that a significant health threat requires emergency response measures. In healthcare, a PHE can trigger temporary flexibilities that affect coverage, telehealth, billing, and compliance across Medicaid, Medicare, and payer systems. Learn more.

A CMS program that requires providers to use certified electronic health record (EHR) technology to support secure data exchange, patient access, e-prescribing, and public health reporting, replacing the former Meaningful Use program as part of the Quality Payment Program (QPP). Learn more.

A signed medical order that documents a patient’s treatment preferences for critical or end-of-life care. Unlike an advance directive, a POLST guides immediate clinical decisions and travels with the patient across care settings. Learn more.

A standardized code on a healthcare claim that identifies the setting where care was provided. POS codes are used by Medicare and other payers to apply coverage, reimbursement, and billing rules. Learn more.

A Medicare reimbursement method that pays a fixed, predetermined rate for a defined unit of care based on standardized classification groups rather than actual provider costs. PPS is used across multiple care settings to promote payment predictability and operational efficiency. Learn more.

The individualized preventive-care planning services required as part of the Medicare Annual Wellness Visit. PPPS use a Health Risk Assessment and clinical history to produce a written, patient-specific prevention roadmap for the next 12 months. Learn more.

A Medicaid program that assigns certain members to a single primary care provider and pharmacy to oversee most non-emergency care. It is designed to improve safety, reduce fragmented or potentially unsafe service use, and support coordinated, accountable care for high-risk members. Learn more.

A Medicare-only enrollment identifier assigned by a Medicare Administrative Contractor to confirm an approved billing relationship linked to a provider’s NPI. Learn more.

An organization-wide, data-driven framework that combines quality monitoring with continuous performance improvement to strengthen care quality, patient safety, and operational reliability over time. Learn more.

A CMS-contracted entity that performs Level 2 reconsideration appeals for Original Medicare claims after a MAC redetermination, issuing an independent coverage decision based on Medicare policy and documentation.

A Medicare patient who qualifies for financial assistance with their Part A and Part B premiums, based on limited income and resources. Learn more.

Private entities contracted by the Centers for Medicare & Medicaid Services (CMS) to identify and recover improper Medicare and Medicaid payments. Authorized under Section 1893(h) of the Social Security Act, RACs review paid claims for accuracy, compliance, and documentation integrity. Their findings help prevent overpayments, ensure equitable reimbursement, and strengthen federal healthcare program integrity through transparent audit and recovery processes. Learn more.

A standardized long-term care assessment framework implemented through MDS 3.0 to evaluate resident needs, trigger Care Area Assessments, and guide interdisciplinary care planning and quality monitoring. Learn more.

Standardized codes used in healthcare billing to provide narrative details about claim adjustments or denials. Appearing on Explanations of Benefits (EOBs) and Electronic Remittance Advices (ERA 835), RARCs work alongside CARC codes to give providers the context needed for appeals, compliance, and revenue cycle management.  Learn more.

The reimbursement system used by Medicare and many payers to determine physician payment rates. It assigns Relative Value Units (RVUs) based on physician work, practice expense, and malpractice risk, adjusted by geography and multiplied by a conversion factor to calculate reimbursement. Learn More. 

A federally certified healthcare facility that provides primary and preventive services in rural and medically underserved areas. Administered by CMS, RHCs use a cost-based reimbursement model called the All-Inclusive Rate (AIR) to ensure fair payment for rural providers and expanded access to essential care.  Learn more.

Utilizes technology and real-time data to monitor and manage patient therapy remotely. Learn more.

Utilizes technology and real-time data to monitor and manage patient therapy remotely. Learn more.

A facility that contains the staff and equipment needed to provide skilled nursing care, skilled rehabilitation, and other health-related services. Learn more.

A comprehensive, standardized clinical terminology used worldwide to encode medical concepts, including diagnoses, findings, procedures, anatomy, and substances. Unlike ICD-10, which is primarily for billing, SNOMED CT captures detailed clinical information for electronic health records (EHRs), interoperability, analytics, and value-based care. It is maintained by SNOMED International and adopted in more than 40 countries. Learn more.

Formal requests submitted by state Medicaid agencies to the Centers for Medicare & Medicaid Services (CMS) to modify their Medicaid State Plan. Authorized under Title XIX of the Social Security Act, SPAs define how states implement program changes to eligibility, benefits, or payment methodologies. Each SPA requires CMS review and approval to ensure compliance with federal law, fiscal integrity, and equity in Medicaid administration. Learn more.

The Medicare-required written prescription for DMEPOS items. It must include specific patient, item, and practitioner elements and be signed and dated by the treating practitioner to support compliant delivery and reimbursement. Learn more.

The IRS-issued tax ID—usually an EIN—used to identify the legal healthcare billing entity for payer enrollment, claims submission, and reimbursement routing. Learn more.

A Medicare medical review program conducted by Medicare Administrative Contractors (MACs) to assess medical necessity, documentation sufficiency, and billing accuracy for selected services. TPE uses probe samples, individualized education, and corrective action opportunities across up to three rounds. Providers who fail to improve may face escalations such as 100% prepayment review, extrapolated overpayments, or referral to UPIC for further investigation. Learn more.

Organizations contracted by the Centers for Medicare & Medicaid Services (CMS) to detect, prevent, and investigate fraud, waste, and abuse across Medicare and Medicaid. UPICs replaced the former Zone Program Integrity Contractors (ZPICs) and Medicaid Integrity Contractors (MICs), consolidating program integrity functions under one unified framework. They conduct data analysis, medical reviews, and investigations to ensure federal funds are used appropriately and providers comply with CMS regulations. UPICs work closely with MACs, RACs, and the Office of Inspector General (OIG) to maintain fiscal integrity, equity, and accountability in federal healthcare programs. Learn more.

A federal Medicaid payment ceiling established by the Centers for Medicare & Medicaid Services (CMS). It defines the maximum aggregate amount a state can reimburse certain provider classes—such as hospitals and nursing facilities—without exceeding what Medicare would pay for the same services. States use UPL calculations and supplemental payments to maintain provider stability and access while ensuring compliance with federal funding limits. Learn more.

Outcome-focused care model that rewards providers for improving patient health and coordinating care effectively. Learn more.

A CMS demonstration that allows Medicare Advantage plans to vary benefits and cost-sharing to promote high-value care. By lowering costs for preventive services, chronic condition management, and evidence-based treatments, VBID aims to improve patient outcomes and reduce unnecessary spending while advancing equity in healthcare access. Learn more.

Z codes are ICD-10-CM diagnosis codes (Z00–Z99) used to document factors that influence a patient’s health but are not diseases or injuries. They include reasons for encounters, medical and family history, and social determinants of health (SDOH) such as housing or food insecurity. While Z codes do not directly affect reimbursement, they provide valuable data for population health, quality reporting, and value-based care initiatives. Learn more.