Overview

For years, providers and payers have recognized that social determinants of health (SDOH) — things like food, housing, transportation, and employment — drive the majority of health outcomes. But despite this awareness, the system lacked a clear way to document needs and reimburse interventions.

That changes in 2025. With CMS expanding the use of Z Codes and introducing new G Codes, health systems, plans, and community-based organizations now have a connected pathway that finally makes SDOH a billable, measurable, and reportable part of care.

Z Codes: The Foundation of Documentation

Z Codes (ICD-10-CM Z55–Z65) have long existed as a tool for capturing SDOH needs in the medical record. Examples include:

• Z59.0 — Homelessness
• Z59.4 — Lack of adequate food
• Z63.4 — Disappearance and death of family member

Historically, these codes provided visibility without reimbursement. Providers could note the challenge, but the work of addressing it — care navigation, community referrals, and follow-up — went unpaid.

G Codes: Closing the Loop With Reimbursement

Enter the new 2025 G Codes for Health-Related Social Needs (HRSN). These codes allow providers and community-based organizations to bill for the actual services delivered to address documented needs, such as:

• SDOH screenings and assessments
• Referrals and care navigation
• Follow-up and closed-loop coordination
• Community-based interventions integrated into care plans

In short: Z Codes identify the problem, G Codes reimburse the solution.

Why This Matters for Providers, Plans, and CBOs

The combined Z + G Code framework transforms SDOH from a compliance box-check into a core part of care delivery and financial sustainability:

• Compliance Alignment: CMS and NCQA now tie Z + G activity to quality measures like HEDIS Social Needs Screening (SNS-E).
• Revenue Opportunities: Organizations that operationalize screenings and navigation can unlock new reimbursement streams.
• Population Health Insights: Together, Z + G Codes provide data that show not just needs but also the impact of interventions.
• Network Integration: To fully leverage G Codes, health systems must credential and contract with community-based organizations — creating true closed-loop ecosystems.

How Wellup Bridges Z + G Codes Seamlessly

Wellup was designed with this shift in mind:

• Automated Z Codes: Member assessments automatically generate Z Codes, reducing manual documentation.
• Navigator Workflows for G Codes: Care teams can bill accurately as they close referrals and interventions.
• Compliance-Ready Reporting: Dashboards track longitudinal progress over a dozen key social factors, delivering the documentation payers and auditors require.
• Actionable Insights: Beyond compliance, Wellup’s reporting highlights where interventions drive the greatest outcomes and ROI.

The 2025 Takeaway

This year marks the first time the healthcare system has a complete SDOH framework:

1. Z Codes document social needs.
2. G Codes reimburse interventions.
3. Data closes the loop — proving outcomes, driving quality scores, and unlocking financial sustainability.

Organizations that act now will not only meet CMS mandates but also lead the way in reshaping how healthcare and community services come together to improve lives.

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