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

Reviewed 9/19/2024