Reimbursement Related to Z59.00-Z59.9
CMS made several changes in the 2024 CY Physician Fee Schedule (PFS) and FY 2024 Inpatient Prospective Payment System/Long-Term Care Hospital Prospective Payment System (IPPS/LTCH PPS) rules to recognize the role that social determinants, drivers, and needs can play in patient health outcomes.
Many of the changes can mean additional or different reimbursement when documenting SDOH related to housing under category Z59, including:
- Z59.00 Homelessness unspecified
- Z59.01 Sheltered homelessness
- Z59.02 Unsheltered homelessness
Select each heading below to learn more about category Z59.
For more information, review the Health Equity Services in the 2024 Physician Fee Schedule Final Rule booklet. We also discuss this in more detail in Lesson 3.
Under the direction of a physician, a community health worker meets with a patient after the physician finds out the patient is unhoused and sleeping in their car.
They document this lack of housing with the appropriate code in category Z59, Z59.02 Unsheltered homelessness, and refer the patient to housing support services.
Under 2024 changes to the PFS rule, because the patient had an initiating visit with the physician and the community health worker meets applicable state requirements, the physician can bill G codes G0019 and G0022 for provision of Community Health Integration services. CMS allows payment for up to 18 hours of Community Health Integration services per year.
A patient is discharged from a hospital after treatment for shortness of breath related to asthma.
The attending physician conducts an SDOH Risk Assessment and discovers that, in the patient’s home, water leaks often lead to mold buildup. The physician documents the problems related to housing and reports the appropriate code from category Z59, Z59.19 Other inadequate housing.
Under 2024 changes to the PFS rule, because the SDOH assessment was done as part of an evaluation and management (E/M) visit and an assessment hadn’t been done in the 6 months prior, the physician can bill G code G0136 for the time spent conducting the SDOH assessment.
In FY 2024, CMS changed the severity level designation for 3 SDOH diagnosis codes related to homelessness to account for homelessness as an indicator of increased resource usage in inpatient hospital settings.