Medicare Diabetes Prevention Program (MDPP) Expanded Model Billing Codes May be reported with Modifier VM HCPCS G-Code for Payment (virtual make-up Description of Service session) MDPP Services Amount G9873 $25.00 1st Cores Session Attended No G9874 $50.00 4 core sessions attended Yes G9875 $90.00 9 total core sessions attended Yes G9876 $15.00 2 core maintenance sessions attended months 7-9 Yes (weight loss goal not achieved) G9877 $15.00 2 core maintenance sessions attended months 10-12 Yes (weight loss goal not achieved or maintained) $60.00 2 core maintenance sessions attended months 7-9 Yes (weight loss goal achieved) $60.00 2 core maintenance sessions attended months 10-12 Yes (weight loss goal achieved or maintained) G9880 $160.00 5% weight loss from baseline achieved No G9881 $25.00 9% weight loss from baseline achieved No G9882 $50.00 2 ongoing maintenance sessions attended in months 13-15 and weight Yes loss goal maintained G9883 $50.00 2 ongoing maintenance sessions attended in months 16-18 and weight Yes loss goal maintained G9884 $50.00 2 ongoing maintenance sessions attended in months 19-21 and weight Yes loss goal maintained G9885 $50.00 2 ongoing maintenance sessions attended in months 22-24 and weight Yes loss goal maintained G9890 $25.00 Bridge Payment session furnished by an MDPP supplier for a Yes – beneficiary who has previously received MDPP services with another supplier. G9891 $0.00 Session reported as a line-item on a claim Yes
Medicare Diabetes Prevention Program (MDPP) Expanded Model Billing Codes HCPCS G-Code for MDPP Services Payment Amount Description of Service May be reported with Modifier VM (virtual make-up session) G9873 $25.00 1st Cores Session Attended No G9874 $50.00 4 core sessions attended Yes G9875 $90.00 9 total core sessions attended Yes G9876 $15.00 2 core maintenance sessions attended months 7-9 (weight loss goal not achieved) Yes G9877 $15.00 2 core maintenance sessions attended months 10-12 (weight loss goal not achieved or maintained) Yes $60.00 2 core maintenance sessions attended months 7-9 (weight loss goal achieved) Yes $60.00 2 core maintenance sessions attended months 10-12 (weight loss goal achieved or maintained) Yes G9880 $160.00 5% weight loss from baseline achieved No G9881 $25.00 9% weight loss from baseline achieved No G9882 $50.00 2 ongoing maintenance sessions attended in months 13-15 and weight loss goal maintained Yes G9883 $50.00 2 ongoing maintenance sessions attended in months 16-18 and weight loss goal maintained Yes G9884 $50.00 2 ongoing maintenance sessions attended in months 19-21 and weight loss goal maintained Yes G9885 $50.00 2 ongoing maintenance sessions attended in months 22-24 and weight loss goal maintained Yes G9890 $25.00 Bridge Payment – session furnished by an MDPP supplier for a beneficiary who has previously received MDPP services with another supplier. Yes G9891 $0.00 Session reported as a line-item on a claim Yes