Z60.4 ICD-10-CM Code: Social exclusion and rejection
Z60.4 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · free HCC coding tools
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Factors influencing health status and contact with health services (Z00-Z99) / Persons with potential health hazards related to socioeconomic and psychosocial circumstances (Z55-Z65)
Z60.4
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceSocial exclusion and rejection
A person is experiencing social exclusion, rejection, or isolation from their community or peer groups.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Exclusion and rejection on the basis of personal characteristics, such as unusual physical appearance, illness or behavior.
- Social isolation
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for Z60.4 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for Z60.4 in this effective period.
Excludes 1
Official- target of adverse discrimination such as for racial or religious reasons (Z60.5)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for Z60.4 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for Z60.4 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for Z60.4 in this effective period.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is Z60.4 an HCC code?
No. Z60.4 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- Z60.4
- Description
- Social exclusion and rejection
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
Get the V28 RAF + MEAT cheat sheet
One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.
Free PDF. No card. Unsubscribe anytime.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
Z60.4 is the ICD-10-CM diagnosis code for social exclusion and rejection. A person is experiencing social exclusion, rejection, or isolation from their community or peer groups. Z60.4 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering persons with potential health hazards related to socioeconomic and psychosocial circumstances (z55-z65).
Z60.4 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This code helps identify patients at risk for mental health complications and may warrant psychological support or social services.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Z60.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code helps identify patients at risk for mental health complications and may warrant psychological support or social services
- •Document the context of exclusion and any resulting health impacts in the clinical record
Excludes 1, Do NOT code together
- target of adverse discrimination such as for racial or religious reasons (Z60.5)