HCPCS G9875: MDPP Nine Core Sessions, Expanded Model

HCPCS Level II code G9875 documents that a Medicare Diabetes Prevention Program (MDPP) beneficiary attended nine MDPP core sessions under the MDPP Expanded Model (EM). The code captures completion of a substantial portion of the MDPP core phase (months 1–6), reflecting engagement with a CDC-approved diabetes prevention curriculum delivered in roughly one-hour sessions. Nationally, this code matters because it tracks structured preventive care aimed at reducing incidence of type 2 diabetes and informs quality and reimbursement workflows tied to program participation.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what G9875 represents, the service type (behavioral preventive health/diabetes prevention education), and typical sites of service used by MDPP suppliers. The publication outlines how G9875 fits into clinical workflows and billing operations and highlights benchmarks and policy context relevant to program delivery and payer coverage. Data not available in the input includes associated taxonomies, ICD-10 diagnoses, and related billing codes, which are not included here.

Billing Code Overview

HCPCS Level II code G9875 indicates that an MDPP beneficiary attended nine total Medicare Diabetes Prevention Program (MDPP) core sessions under the MDPP Expanded Model (EM). A core session is an MDPP service that is: (1) furnished by an MDPP supplier during months 1 through 6 of the MDPP services period; (2) approximately 1 hour in length; and (3) delivered following a CDC-approved DPP curriculum for core sessions.

Service Type: Behavioral preventive health/diabetes prevention education sessions

Typical Site of Service: Community or outpatient group setting, virtual delivery, or supplier-designated locations used by MDPP providers, as these are standard venues for MDPP core sessions under the expanded model.

Clinical Context

A Medicare beneficiary with prediabetes (impaired fasting glucose or elevated A1c not meeting diabetes thresholds) enrolls in the Medicare Diabetes Prevention Program (MDPP) Expanded Model (EM). The beneficiary attends a series of CDC-recognized core sessions delivered by an MDPP supplier during months 1–6 of the MDPP services period. After initial intake and baseline risk assessment (including weight, BMI, and hemoglobin A1c or fasting glucose documentation if available), the beneficiary participates in weekly group or virtual MDPP core sessions, each approximately one hour long. This claim represents attendance at the ninth core session.

Workflow:

The beneficiary is referred by a primary care clinician or self-enrolls with an MDPP supplier.
During the intake visit, the supplier documents eligibility, baseline measurements, and obtains informed consent for program participation.
The supplier delivers CDC-approved DPP curriculum content in scheduled one-hour core sessions (weeks 1–9+), recording attendance for each session.
After the ninth session, the supplier records the attendance event and bills G9875 to Medicare under the MDPP Expanded Model. Attendance records and supporting documentation (session date, duration ~1 hour, curriculum adherence, and beneficiary identity) are retained for audit and quality reporting.
Ongoing data collection continues for behavior change metrics (weight loss, physical activity) and continued sessions beyond month 6 as applicable.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier; standard billing	Use when no special circumstances apply and full service is rendered.

Taxonomy Code	Specialty	Notes
`351H00000X`	Health Education/Promotion	Typical supplier specialty delivering MDPP core sessions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R73.03`	Prediabetes	Primary diagnosis indicating impaired glucose tolerance or elevated A1c where MDPP enrollment is clinically indicated.

| R73.01 | Impaired fasting glucose | Specific abnormal fasting glucose supporting eligibility for MDPP.

| Z71.3 | Dietary counseling and surveillance | Used when counseling for diet is provided as part of MDPP activities.

| Z71.89 | Other specified counseling | Captures lifestyle and behavior counseling related to diabetes prevention.

| E66.9 | Obesity, unspecified | Common comorbidity targeted by weight-loss and lifestyle interventions in MDPP.

| Z72.0 | Lack of physical exercise | Behavioral risk factor addressed by MDPP physical activity goals.

| Z13.1 | Encounter for screening for diabetes mellitus | Used for initial screening encounters that may lead to MDPP referral.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	May be provided in primary care visits preceding or concurrent with MDPP enrollment for behavioral risk counseling.

| 99407 | Smoking and tobacco use cessation counseling visit, intensive, greater than 10 minutes | Similar relation as 99406 when more intensive counseling occurs during clinical visits tied to lifestyle change.

| G0447 | Face-to-face behavioral counseling for obesity, 15 minutes | May be used by clinicians for weight management counseling that complements MDPP sessions.

| 96127 | Brief emotional/behavioral assessment (e.g., PHQ-2, PHQ-9) | Used to screen for depression or behavioral barriers before or during MDPP participation.

| 99401 | Preventive medicine counseling, individual, approximately 15 minutes (historical — replaced by newer codes in some payers) | Represents preventive counseling services that may be documented in primary care visits related to lifestyle change; use per payer policy.

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Summary & Overview