- Learn About MDPP
- Framework for Prevention and Goals
- Delivering a Lifestyle Change for Medicare Beneficiaries
- Receiving CDC Recognition and Medicare Enrollment
- Medicare MDPP Coverage
- Medicare MDPP Coverage Beginning 1/1/2022
- MDPP Codes and Payment Amounts
- MDPP Billing Information
- Accessing Eligibility for MDPP in NGSConnex
- Contact Information and Resources
MDPP Codes and Payment Amounts
- 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 | 2022 Payment Amount | 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. | $35 | $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. | $105 | $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. | $175 | $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 |
$75 | $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. |
$75 | $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. |
$93 | $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. |
$93 | $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. | $169 | $184 | No |
| G9881 | The MDPP beneficiary achieved at least 9% weight loss from his/her baseline weight in months 1-24 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. | $35 | $38 | No |
| G9882 | Two MDPP ongoing maintenance sessions were attended by an MDPP beneficiary in months 13-15 under the MDPP Expanded Model. An ongoing maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 13 through 24 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 maintained at least 5% weight loss from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 13-15 | *$52 | *$57 | Yes |
| G9883 | Two MDPP ongoing maintenance sessions were attended by an MDPP beneficiary in months 16-18 under the MDPP Expanded Model. An ongoing maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 13 through 24 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 maintained at least 5% weight loss from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 16-18. | *$52 | *$57 | Yes |
| G9884 | Two MDPP ongoing maintenance sessions were attended by an MDPP beneficiary in months 19-21 under the MDPP Expanded Model. An ongoing maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 13 through 24 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 maintained at least 5% weight loss from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 19-21. |
*$53 | *$58 | Yes |
| G9885 | Two MDPP ongoing maintenance sessions were attended by an MDPP beneficiary in months 22-24 under the MDPP Expanded Model. An ongoing maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 13 through 24 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 maintained at least 5% weight loss from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 22-24 |
*$53 | *$58 | Yes |
| 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 1-24 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. | $35 | $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 | $0 | Yes |
*In CY 2022, CMS removed the ongoing maintenance sessions for those beneficiaries who started MDPP set of services on or after 1/1/2022. MDPP beneficiaries who were participating in the MDPP set of services on or before 12/31/2021 may continue with the ongoing maintenance phase if they maintain 5 percent weight loss and attendance requirements.
Revised 12/29/2022