Medicare Diabetes Prevention Program

MDPP Codes and Payment Amounts 2023

  • HCPCS G-codes are used when submitting claims to bill Medicare for payment. MDPP HCPCS G-codes may be used only one time per eligible beneficiary (except for G9890 and G9891).
  • The initial session (G9873) or bridge payment (G9890) claim must be submitted before any other claims will be paid.
  • MDPP suppliers should submit claims when a performance goal is met.
  • Use the nonpayable G-code (G9891) to report attendance at sessions that are not associated with a performance goal. These codes should be listed on the same claim as the payable code with which they are associated (e.g., report G9891 for sessions two and three if you are reporting G9874 for session four attendance).
  • Each HCPCS G-code should be listed with the corresponding session date of service and rendering coach NPI.
  • If a beneficiary switches suppliers, the new supplier may receive a bridge payment (G9890) for the first MDPP session furnished to that beneficiary. More than one supplier may claim a bridge payment for the same beneficiary.
  • The virtual modifier, “VM,” should be appended to the end of any G-code associated with a session that was furnished as a virtual make-up session (e.g., G9891VM).
HCPCS G-Code Description of MDPP Service 2023 Payment Amount May be reported with Modifier VM (Virtual Make Up Session)
G9873 First MDPP core session was attended by an MDPP beneficiary under the MDPP Expanded Model. A core session is an MDPP service that: (1) is furnished by an MDPP supplier during months 1 through 6 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for core sessions. $38 No
G9874 Four total MDPP core sessions were attended by an MDPP beneficiary under the MDPP Expanded Model. A core session is an MDPP service that: (1) is furnished by an MDPP supplier during months 1 through 6 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for core sessions. $115 Yes
G9875 Nine total MDPP core sessions were attended by an MDPP beneficiary under the MDPP Expanded Model. A core session is an MDPP service that: (1) is furnished by an MDPP supplier during months 1 through 6 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for core sessions. $191 Yes
G9876 Two MDPP core maintenance sessions were attended by an MDPP beneficiary in months 7-9 under the MDPP Expanded Model .A core maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 7 through 12 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions.

The beneficiary did not achieve at least 5% weight loss from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9		 $76 Yes
G9877 Two MDPP core maintenance sessions were attended by an MDPP beneficiary in months 10-12 under the MDPP Expanded Model. A core maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 7 through 12 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions.

The beneficiary did not achieve at least 5% weight loss from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12.		 $76 Yes
G9878 Two MDPP core maintenance sessions were attended by an MDPP beneficiary in months 7-9 under the MDPP Expanded Model. A core maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 7 through 12 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions.

The beneficiary achieved at least 5% weight loss from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9.		 $101 Yes
G9879 Two MDPP core maintenance sessions were attended by an MDPP beneficiary in months 10-12 under the MDPP Expanded Model. A core maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 7 through 12 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions.

The beneficiary achieved at least 5% weight loss from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12.		 $101 Yes
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. $184 No
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. $38 No
G9886 Behavioral counseling for diabetes prevention, in-person, group, 60 minutes

New as of 1/1/2024		 N/A TBD
G9887 Behavioral counseling for diabetes prevention, distance learning, group, 60 minutes

New as of 1/1/2024		 N/A TBD
G9888 Maintenance 5% weight loss from baseline weight in months 7-12

New as of 1/1/2024		 N/A TBD
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. $38 Yes
G9891 MDPP session reported as a line-item on a claim for a payable MDPP Expanded Model HCPCS code for a session furnished by the billing supplier under the MDPP Expanded Model and counting toward achievement of the attendance performance goal for the payable MDPP Expanded Model HCPCS code. (This code is for reporting purposes only). $0 Yes


Revised 2/6/2024