Summary & Overview

HCPCS G9874: MDPP Four Core Sessions, Expanded Model

HCPCS Level II code G9874 documents that a Medicare Diabetes Prevention Program (MDPP) beneficiary attended four core sessions under the MDPP Expanded Model (EM). Core sessions are approximately one hour long, delivered by an MDPP supplier during months 1–6 of the MDPP services period, and follow a CDC‑approved diabetes prevention curriculum. The code is relevant nationally as MDPP participation is a public‑health priority aimed at reducing progression to type 2 diabetes and lowering downstream clinical costs.

Key payers covered include Aetna, Blue Cross Blue Shield plans, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context and service setting, plus what to expect in payer coverage patterns and benchmarks for MDPP delivery under the expanded model. The publication outlines common billing considerations tied to session counts, timing within the MDPP service period, and how this code fits into reporting of preventive behavioral interventions.

This resource provides an operational summary for billing teams, program managers, and policy analysts: definitions for the service represented by G9874, the typical delivery setting, payer coverage landscape, and pointers to where to find additional policy updates and implementation guidance. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9874HCPCS Level IIMedicare Diabetes Prevention ProgramMDPP Expanded Modelpreventive servicesdiabetes preventioncore session attendanceCDC DPP curriculumbehavioral health interventions

Billing Code Overview

HCPCS Level II code G9874 represents attendance at four total Medicare Diabetes Prevention Program (MDPP) core sessions 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.

Service Type: Preventive lifestyle intervention — diabetes prevention core session attendance

Typical Site of Service: Community-based or virtual MDPP supplier settings (services delivered by an MDPP supplier during months 1–6 of the MDPP service period).

Clinical & Coding Specifications

Clinical Context

A 55-year-old Medicare beneficiary with prediabetes (impaired fasting glucose identified during routine primary care screening) enrolls in the Medicare Diabetes Prevention Program Expanded Model. The beneficiary attends the MDPP core curriculum during months 1–6. After referral from their primary care clinician, the beneficiary schedules group-based weekly core sessions of approximately one hour each led by an MDPP supplier (a trained lifestyle coach) in an outpatient community wellness center. The clinical workflow includes referral and enrollment, baseline weight and hemoglobin A1c review, documentation of attendance for each core session, delivery of CDC-approved DPP curriculum content (nutrition education, physical activity, behavior change strategies), periodic brief weight checks and goal setting, and claims submission for each attended core session using HCPCS Level II code G9874. Attendance tracking and progress notes are maintained in the supplier’s EHR or program registry and shared with the beneficiary’s referring clinician as needed for continuity of care.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier reported	Use when no special modifier applies to the MDPP service claim for `G9874`.
`22`	Increased procedural services	Use if substantially greater intensity, time, or effort was required for a specific MDPP session and documentation supports unusual services.
`23`	Unusual anesthesia	Not typically applicable to MDPP; included for completeness but rarely used.
`52`	Reduced services	Use when an MDPP core session was partially provided or shortened and documentation supports reduced service.
`53`	Discontinued procedure	Use if an MDPP session was started but discontinued due to beneficiary intolerance or acute event, with documentation.
`55`	Postoperative care only	Not applicable to MDPP; reserved for surgical global period situations.
`62`	Two surgeons	Not applicable to MDPP; reserved for surgical services.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use when the MDPP core session was delivered live via telehealth with interactive audio/video.
`QX`	Ordering/Referring Provider Not Eligible to Be Paid	Use when the referring clinician is not the billing provider and payer rules require this modifier.
`QY`	Attending physician not identified / certification & plan of care not furnished	Use per payer guidance when requirements for physician certification of MDPP participation are not furnished.

Taxonomy Code	Specialty	Notes
`Data not available in the input.`	Data not available in the input.	Data not available in the input.
`Data not available in the input.`	Data not available in the input.	Data not available in the input.
`Data not available in the input.`	Data not available in the input.	Data not available in the input.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E66.9`	Obesity, unspecified	Obesity is a common comorbidity and risk factor for type 2 diabetes; often addressed within DPP lifestyle content.
`R73.03`	Prediabetes	Directly indicates impaired glucose regulation and is a primary clinical indication for enrollment in MDPP.
`R73.01`	Impaired fasting glucose	A common laboratory finding prompting referral to MDPP for diabetes prevention interventions.
`Z71.3`	Dietary counseling and surveillance	Reflects counseling encounters related to nutrition advice provided during MDPP participation.
`Z71.82`	Exercise counseling	Indicates counseling for physical activity, integral to MDPP core session objectives.
`Z13.1`	Encounter for screening for diabetes mellitus	Screening encounters that identify candidates for MDPP enrollment.
`E11.9`	Type 2 diabetes mellitus without complications	May be present in beneficiaries transitioning from prediabetes; eligibility rules vary but monitoring is clinically relevant.
`Z71.89`	Other specified counseling	Used for behavioral or health education counseling sessions included in MDPP core curriculum.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99401`	Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual; approximately 15 minutes	May be used for brief individualized preventive counseling visits that precede or supplement group MDPP sessions when billed under appropriate payer rules.
`99402`	Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual; approximately 30 minutes	Used for longer individual preventive counseling visits related to lifestyle modification when provided in addition to MDPP core sessions.
`99403`	Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual; approximately 45 minutes	Used for extended individual counseling visits supporting weight-loss or behavior-change goals alongside the MDPP curriculum.
`G0447`	Face-to-face behavioral counseling for obesity, 15 minutes	May be billed for obesity counseling services that align with lifestyle intervention efforts when payer allows concurrent billing.
`S9470`	Nutrition counseling, dietitian visit	Commonly provided before or during the MDPP program for individualized medical nutrition therapy or counseling referrals.