Social Determinants of Health (SDOH)
Social Determinants of Health
Non-medical factors influencing health outcomes — housing, food security, transportation, employment, education, and social support.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Coding
- Acronym for
- Social Determinants of Health
- Primary sources
- 1
- Workspace handoff
- templates →
Where this comes up
Coders meet this term inside the chart at the moment of code selection — picking the E/M level, attaching the right modifier, defending the procedure code against an NCCI edit, or answering an auditor who pulled the encounter for a payer-initiated review.
Full definition
What it is in practice
CDC SDOH framework drives screening initiatives. ICD-10-CM Z55-Z65 codes document SDOH. MIPS measures and ACO quality programs increasingly reward SDOH screening.
How it shows up in your practice
Standardize SDOH screening (PRAPARE, AHC HRSN, Health Leads). Document screening results and referrals. Capture matching Z codes.
Sources
- CMS — Quality Payment Programhttps://qpp.cms.gov/
Use SDOH screening templates
Open templates →Related terms
- CodingICD-10-CM Z CodeICD-10-CM categories Z00-Z99 used to document encounters for reasons other than disease or injury, including screenings, follow-up, social determinants, and personal/family history.
- DocumentationHCC (Hierarchical Condition Category)The CMS risk-adjustment model that groups ICD-10 codes into categories used to predict the cost of care for Medicare Advantage enrollees.
- Compliance ProgramValue-Based CareReimbursement models that pay providers based on quality and outcomes rather than fee-for-service volume.
- Compliance ProgramMIPSMerit-based Incentive Payment System — the QPP track combining quality, cost, improvement activities, and promoting interoperability into a single composite score that adjusts Medicare payment.
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Related across the archive
- GlossaryValue-Based CareReimbursement models that pay providers based on quality and outcomes rather than fee-for-service volume.
- GlossaryICD-10-CM Z CodeICD-10-CM categories Z00-Z99 used to document encounters for reasons other than disease or injury, including screenings, follow-up, social determinants, and personal/family history.
- GlossaryHCC (Hierarchical Condition Category)The CMS risk-adjustment model that groups ICD-10 codes into categories used to predict the cost of care for Medicare Advantage enrollees.
- GlossaryMIPSMerit-based Incentive Payment System — the QPP track combining quality, cost, improvement activities, and promoting interoperability into a single composite score that adjusts Medicare payment.
- GlossaryAccountable Care Organization (ACO)A group of providers that takes accountability for the quality, cost, and overall care of a defined patient population.
- GlossaryReadmission Reduction Program (HRRP)CMS program that reduces payments to hospitals with excess 30-day readmissions for certain conditions.
- GlossaryQuality Payment Program (QPP)CMS framework that combines MIPS and Advanced APMs to tie physician Medicare payments to quality and value.
- Billing99214 vs 99215: When to Bill Each CodeLearn the difference between 99214 and 99215: when each applies, what documentation you need, and the $40/visit revenue impact.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.