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 a HCFA-1500 claim form. All submitted claims are payable once per lifetime.
| Code | Description |
|---|---|
| G9873 | First DPP core session was attended. A core session is an MDPP service that: (1) is furnished during months 1 through 6 of the DPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for core sessions |
| G9874 | Four total DPP core sessions were attended |
| G9875 | Nine total DPP core sessions were attended |
| G9876 | Two DPP core maintenance sessions (MS) were attended in months (mo) 7-9 under the MDPP Expanded Model (EM). 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 (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9. |
| G9877 | Two DPP core maintenance sessions (MS) were attended in months (mo) 10-12 The beneficiary did not achieve at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12. |
| G9878 | Two DPP core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 7-9 The beneficiary achieved at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9. |
| G9879 |
Two DPP core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 10-12. The beneficiary achieved at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 10-12 |
| 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. |
| 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 |
| G9882 |
Two DPP ongoing maintenance sessions (MS) were attended by an DPP beneficiary in months (mo) 13-15. The beneficiary maintained at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 13-15. |
| G9883 | Two DPP ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 16-18 The beneficiary maintained at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 16-18. |
| G9884 | Two DPP ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 19-21 The beneficiary maintained at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 19-21. |
| G9885 | Two DPP ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 22-24 The beneficiary maintained at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 22-24. |
| G9890 | Bridge Payment: A one-time payment for the first Medicare Diabetes Prevention Program (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 (EM) 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. |
| G9891 | MDPP session reported as a line-item on a claim for a payable MDPP Expanded Model (EM) 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). |