HCPCS G9876: MDPP Two Core Maintenance Sessions, Months 7–9 - OpenPayer

Summary & Overview

HCPCS G9876: MDPP Two Core Maintenance Sessions, Months 7–9

HCPCS Level II code G9876 documents attendance at two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions during months 7–9 of the MDPP services period under the Expanded Model. The code captures a specific clinical milestone: in-person participation in approximately one-hour CDC-approved maintenance sessions where the beneficiary did not achieve at least 5% weight loss from baseline. Nationally, this code matters because MDPP is a Medicare-covered preventive service focused on reducing type 2 diabetes onset through structured behavior change programs, and tracking participation during maintenance months informs program adherence and outcome reporting.

Key payers referenced in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what the code represents clinically and operationally, the typical service setting, and which payers are relevant in national coverage discussions. The publication will also cover benchmarks and policy context related to MDPP performance measurement, coding guidance for MDPP suppliers, and comparisons to related MDPP billing activity where available. Data not provided in the input (such as specific payer reimbursement rates, associated taxonomies, and ICD-10 linkage) are noted as not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9876HCPCS Level IIMDPPDiabetes PreventionMaintenance SessionsPreventive CareMedicareCDC DPPOutcomes Measurement

Billing Code Overview

HCPCS Level II code G9876 represents attendance at two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions during months 7–9 under the MDPP Expanded Model (EM). A core maintenance session is an MDPP service furnished by an MDPP supplier during months 7 through 12 of the MDPP services period, is approximately 1 hour in length, and adheres to a CDC-approved DPP curriculum for maintenance sessions. The description indicates the beneficiary did not achieve at least 5% weight loss from baseline as measured by an in-person weight measurement at a core maintenance session in months 7–9.

Service type: MDPP core maintenance sessions (two sessions attended)

Typical site of service: MDPP supplier location or program-delivered site where in-person MDPP maintenance sessions occur

Clinical & Coding Specifications

Clinical Context

A 58-year-old Medicare beneficiary with prediabetes attends two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions during months 7–9 of the MDPP services period under the expanded model. The MDPP supplier conducts in-person one-hour maintenance sessions that follow a CDC-approved DPP curriculum for maintenance content. At an in-person session in month 8 the beneficiary is weighed and the recorded value shows they have not achieved at least 5% weight loss from baseline. The workflow includes patient check-in, a documented in-person weight measurement, delivery of structured maintenance curriculum content by a trained lifestyle coach, documentation of attendance and the measured weight in the beneficiary’s MDPP record, and submission of the HCPCS Level II code G9876 for two attended core maintenance sessions in months 7–9. Typical administrative steps include verifying Medicare eligibility, confirming continued MDPP enrollment, capturing the in-person weight measurement as required for outcome tracking, and attaching any applicable modifier for billing nuances (for example facility or billing circumstances). The typical site of service is an outpatient ambulatory clinic, community health center, or other CDC-recognized MDPP supplier location that provides in-person program sessions.

Coding Specifications

Modifier	Description	When to Use
`00`	No additional modifier (placeholder)

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Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`103K00000X`	Registered Dietitian Nutritionist	Dietitians commonly deliver or co-lead DPP maintenance content focused on weight and lifestyle.
`207Q00000X`	Family Medicine	Primary care clinicians refer and often coordinate MDPP participation for patients with prediabetes.
`111N00000X`	Health Education Specialist	Trained lifestyle coaches and health educators frequently deliver MDPP sessions following CDC curriculum.
`363L00000X`	Community Health Worker	Community-based workers facilitate enrollment, outreach, and in-person session logistics for MDPP.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E66.9`	Obesity, unspecified	Obesity is a common comorbidity and target of weight-loss efforts within MDPP maintenance sessions.
`R73.03`	Prediabetes	Identifies impaired glucose tolerance or elevated risk for type 2 diabetes; primary indication for MDPP enrollment.
`Z71.3`	Dietary counseling and surveillance	Reflects nutritional counseling related to lifestyle change, often provided alongside MDPP.
`Z71.89`	Other specified counseling	Used when counseling for behavioral change related to diabetes prevention is documented.
`Z13.1`	Encounter for screening for diabetes mellitus	Screening encounters that identify candidates for MDPP participation.
`E11.9`	Type 2 diabetes mellitus without complications	Relevant when participants transition from prediabetes to diagnosed diabetes during or after MDPP; impacts eligibility and further care planning.

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 short individualized lifestyle counseling visits related to diabetes prevention but not a substitute for MDPP session reporting; used when billing separate brief counseling in a clinical visit.
`99402`	Preventive medicine counseling, approximately 30 minutes	Used for longer individual preventive counseling visits that may occur in primary care alongside MDPP enrollment or follow-up.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Commonly billed by primary care clinicians for routine follow-up visits where MDPP participation and weight outcomes are discussed and documented.
`99078`	Physician education services provided in a group setting (e.g., prenatal or diabetes clinic), per session	Occasionally used for non-MDPP group diabetes education sessions; separate from CDC-approved MDPP billing.
`G0108`	Diabetes outpatient self-management training services, individual, per 30 minutes	Medicare diabetes education codes used historically for DSMT; may be billed in parallel when DSMT is provided outside MDPP but is distinct from `G9876` billing.

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