MDPP Codes and Payment Amounts 2024

Medicare pays up to 22 visits billed with codes G9886 and G9887, combined, in a 12-month period:

• Months 1–6: one in-person/distance learning visit every week (up to 16)
• Months 7–12: one in-person/distance learning visit every month (up to 6)

Months 7–12: once participant achieves 5% weight loss, supplier may submit maintenance of 5% weight loss claim with attendance claim

(G9888 + G9886/G9887). Medicare will pay for maintenance 5% weight loss up to 6 times in months 7–12

G9880 (5% weight loss) and G9888 (maintenance 5% weight loss in months 7-12) cannot have the same date of service. For example, a date of service for G9880 must be before the first date of service for G9888.

G9880 and G9888 can only be billed with the same date of service as G9886 or G9887.

For any claims with date of service on or after 1/1/2024, the virtual modifier, “VM,” is no longer included. Essentially, virtual delivery of MDPP is now limited to “Distance Learning.” Moreover, online (asynchronous) is not allowed for MDPP.

HCPCS G-Code	Description of MDPP Service	2024 Payment Amount
G9880	The MDPP beneficiary achieved at least 5% weight loss from his/her baseline weight in months 1-12 of the MDPP services period under the MDPP Expanded Model. This is a one-time payment available when a beneficiary first achieves at least 5% weight loss from baseline as measured by an in-person weight measurement at a core session or core maintenance session.	$145
G9881	The MDPP beneficiary achieved at least 9% weight loss from his/her baseline weight in months 1-12 under the MDPP Expanded Model. This is a one-time payment available when a beneficiary first achieves at least 9% weight loss from baseline as measured by an in-person weight measurement at a core session, core maintenance session, or ongoing maintenance session.	$25
G9886	Behavioral counseling for diabetes prevention, in-person, group, 60 minutes New as of 1/1/2024	$25
G9887	Behavioral counseling for diabetes prevention, distance learning, group, 60 minutes New as of 1/1/2024	$25
G9888	Maintenance 5% weight loss from baseline weight in months 7-12 New as of 1/1/2024	$8
G9890	Bridge Payment: A one-time payment for the first MDPP core session, core maintenance session, or ongoing maintenance session furnished by an MDPP supplier to an MDPP beneficiary during months 1-12 of the MDPP Expanded Model who has previously received MDPP services from a different MDPP supplier under the MDPP Expanded Model. A supplier may only receive one bridge payment per MDPP beneficiary.	$25

Posted 2/6/2024