Reimbursement for Diabetes Prevention Program participation

We reimburse our contracted providers offering DPP based on the CMS approved G-codes for participation and successful program outcomes.  

Use the G-codes below when you submit claims to us on an HCFA-1500 claim form. All submitted claims are payable once per lifetime. 

Code	Description
G9880	The DPP beneficiary achieved at least 5% weight loss (WL) from his/her baseline weight in months 1-12 of the DPP services period under the MDPP Expanded Model (EM). 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. The MDPP expanded model allows participants to self-report weight for distance learning sessions until Dec. 31, 2027.
G9881	The DPP beneficiary achieved at least 9% weight loss (WL) from his/her baseline weight in months 1-24 under the MDPP Expanded Model (EM). 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. The MDPP expanded model allows participants to self-report weight for distance learning sessions until Dec. 31, 2027.
G9886	Behavioral counseling for diabetes prevention, in-person, group, 60 minutes
G9887	Behavioral counseling for diabetes prevention, distance learning, 60 minutes
G9888	Maintenance 5% WL from baseline weight in months 7-12

Note: 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 ever month (up to 6)
• Months 7-12, once the participant achieves 5% WL, you may submit a Maintenance of 5% WL claim with an attendance claim (G9888 + G9886/G9887). Medicare will pay for G9888 up to 6 times in months 7-12.