Which Medicare Diabetes Prevention Program Code Is Worth $168 in 2020?

Thu, Nov 14, 2019 --

Medicare

Medicare Diabetes Prevention Program HCPCS code payment

The 2020 payment rates are now available for the Medicare Diabetes Prevention Program (MDPP). Here’s a quick look at the codes, rates, and program resources.

Compare 2019 and 2020 MDPP Payments

The goal of the MDPP Expanded Model is to prevent Medicare beneficiaries who have an indication of prediabetes from developing diabetes. Below you’ll find MDPP HCPCS Level II codes and their 2019 and 2020 payment rates. For full descriptors, see MLN Matters MM11455.

G9873 (First Medicare Diabetes Prevention Program (MDPP) core session was attended by an MDPP beneficiary under the MDPP Expanded Model (EM). 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.)

  • 2019: $26
  • 2020: $26

G9874 (Four total Medicare Diabetes Prevention Program (MDPP) core sessions …)

  • 2019: $51
  • 2020: $52

G9875 (Nine total Medicare Diabetes Prevention Program (MDPP) core sessions …)

  • 2019: $93
  • 2020: $94

G9876 (Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary 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.)

  • 2019: $15
  • 2020: $15

G9877 (Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 10-12 … The beneficiary did not achieve at least 5% weight loss (WL) from his/her baseline weight …)

  • 2019: $15
  • 2020: $15

G9878 (Two Medicare Diabetes Prevention Program (MDPP) 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 …)

  • 2019: $62
  • 2020: $63

G9879 (Two Medicare Diabetes Prevention Program (MDPP) 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 …)

  • 2019: $62
  • 2020: $63

G9880 (The MDPP beneficiary achieved at least 5% weight loss (WL) from his/her baseline weight in months 1-12 of the MDPP services period under the MDPP Expanded Model (EM). This is a one-time payment …)

  • 2019: $165
  • 2020: $168

G9881 (The MDPP 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 )

  • 2019: $26
  • 2020: $26

G9882 (Two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 13-15 … The beneficiary maintained at least 5% weight loss (WL) from his/her baseline weight …)

  • 2019: $51
  • 2020: $52

G9883 (Two Medicare Diabetes Prevention Program (MDPP) 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 …)

  • 2019: $51
  • 2020: $52

G9884 (Two Medicare Diabetes Prevention Program (MDPP) 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 …)

  • 2019: $51
  • 2020: $53

G9885 (Two Medicare Diabetes Prevention Program (MDPP) 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 …)

  • 2019: $51
  • 2020: $53

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.)

  • 2019: $26
  • 2020: $27

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).)

  • 2019: $0
  • 2020: $0

 

Know Where to Go for MDPP Specifics

Diabetes drives up Medicare spending a significant amount … by roughly $42 billion in 2016, according to the CMS Innovation Center MDPP Expanded Model page. To help prevent high-risk patients from developing diabetes, the program includes at least 16 core sessions over six months in a group setting. The classes cover dietary changes, physical activity, and other behavior strategies for weight control. Less intensive monthly follow-up meetings are intended to help patients maintain healthy behaviors. Months seven to twelve include six core maintenance sessions. You can see from the rates above that payments are higher if the patient achieves certain weight loss goals. Months 13 to 24 include 15 ongoing maintenance sessions.

Except for G9890 and G9891, you should report each of the above G codes only once. You also should report the MDPP codes only after the performance goal is met. And remember that you must be enrolled as an MDPP supplier to bill for MDPP services.

Review all the resources on the MDPP Expanded Model page to be sure you aren’t missing any requirements and to get tips like this one from the MDPP Billing and Claims Fact Sheet: “Submit claims as soon as possible. If a beneficiary changes MDPP suppliers and two suppliers submit a claim for furnishing the same service to a beneficiary, the supplier that submits the claim first will be paid. Payments are not based on the date of service.”

What About You?

Do you report MDPP services? What has your experience been?

 

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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