CurrentUnitedHealthcarePolicy N/A

Social Drivers of Health Protocol

Governance of use and submission of ICD-10 diagnostic codes to capture Social Drivers of Health for UnitedHealthcare members across Medicare Advantage, Medicaid, and Commercial products; applies to providers who screen, document, and bill for SDoH. Affects physicians, health professionals, facilities and ancillary providers serving UnitedHealthcare members.

Policy Summary

PayerUnitedHealthcare

PolicySocial Drivers of Health Protocol

Policy CodePolicy N/A

Change TypeInformational (no material changes)

Effective DateOct 1, 2020

Next Review DateN/A

Key ActionProviders are strongly encouraged to routinely screen, document, and submit appropriate ICD-10 code(s) for patients impacted by SDoH.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

ICD-10code set endorsed for SDoH capture

Medicare, Medicaid, Commerciallines of business covered

Oct 1, 2020protocol effective date

Right to auditaudit authority

SDoH Coding Expectations

SDoH coding expectations

Stance and expectations regarding use of SDoH ICD-10 codes

Providers are strongly encouraged to routinely screen, document, and submit appropriate ICD-10 code(s) when a patient is impacted by social drivers of health (SDoH).

Use the ICD-10 codes found in the referenced link when submitting a claim for a member affected by any of the SDoH categories; providers should remain current as the code list may be updated.

Protocol applies to providers of UnitedHealthcare members enrolled in Medicare Advantage, Medicaid, and Commercial products.

UnitedHealthcare may audit claim submissions retrospectively to verify accurate capture of SDoH coding.

ICD-10 Codes and Applicability

Policy Summary

PayerUnitedHealthcare

PolicySocial Drivers of Health Protocol

Policy CodePolicy N/A

Change TypeInformational (no material changes)

Effective DateOct 1, 2020

Next Review DateN/A

Key ActionProviders are strongly encouraged to routinely screen, document, and submit appropriate ICD-10 code(s) for patients impacted by SDoH.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

SDoH ICD-10 codesICD-10

See external ICD-10 SDoH code list

ICD-10 codes associated with social drivers of health (link referenced in policy)

Applicability — Lines of business

Lines of business coveredApplies to all UnitedHealthcare members enrolled in Medicare Advantage, Medicaid, and Commercial products

Scope of applicationApplies to providers of UnitedHealthcare members who screen, document, and submit SDoH ICD-10 codes

Coding system endorsedUnitedHealthcare supports use of the ICD-10 code classification system to capture SDoH

Provider Responsibilities and Audit Authority

Denial Risk

Audit authority — retrospective claim audits

UnitedHealthcare reserves the right to audit claim submissions retrospectively to verify accurate capture of SDoH coding; providers should train staff on billing and coding updates and retain documentation to support claims if audited.

Train staff on updates to billing and coding for SDoH
Retain complete medical diagnosis, recordkeeping, and claim submission documentation

Documentation Required

Provider coding and documentation — screen, document, and code SDoH

Providers are strongly encouraged to routinely screen patients for Social Drivers of Health, document findings in the medical record, and submit the appropriate ICD-10 SDoH code(s) on claims using the ICD-10 codes referenced in the policy link.

Use the ICD-10 codes found in the referenced link when submitting claims for members affected by SDoH
Remain current on SDoH ICD-10 code utilization as codes may be updated

Key Definitions

Social Drivers of Health (SDoH) — definition and examples

Definition (term)Social Drivers of Health (SDoH): Non-clinical societal and environmental conditions that prevent individuals from accessing needed health care

ExamplesLack of access to adequate food and health care; housing instability; transportation barriers; limited education; unsafe environment; inadequate social support; employment and behavioral stability challenges

Purpose of identifying SDoHAllows providers and UnitedHealthcare to collect data and identify solutions to better align care with members' needs