Summary & Overview
HCPCS G9877: MDPP Core Maintenance Sessions, Months 10–12
HCPCS Level II code G9877 represents two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions attended by an MDPP beneficiary during months 10–12 under the MDPP expanded model, where the beneficiary did not achieve at least 5% weight loss from baseline. This code captures late-program maintenance engagement and an outcome threshold relevant to MDPP performance and coverage decisions. Nationally, accurate coding of such MDPP maintenance encounters supports program tracking, quality measurement tied to the CDC-approved DPP curriculum, and Medicare program payment and reporting.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical and billing context for G9877, how the service is defined and typically delivered, and the relevance of the 5% weight-loss threshold for MDPP reporting. The publication outlines billing practice considerations, common modifiers, and how this code relates to MDPP service periods and maintenance-session timing. It also highlights where input data is not available, such as associated taxonomies, ICD-10 diagnoses, and related codes, which are noted as "Data not available in the input."
Billing Code Overview
HCPCS Level II code G9877 describes two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions attended by an MDPP beneficiary during months 10–12 under the MDPP expanded model (EM). A core maintenance session is an MDPP service furnished 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 code indicates that the beneficiary did not achieve at least 5% weight loss from baseline, as measured by at least one in-person weight measurement at a core maintenance session in months 10–12.
Service Type: MDPP core maintenance sessions (months 10–12)
Typical Site of Service: MDPP supplier–led in-person group or individual session following CDC-approved curriculum, delivered during the MDPP expanded model service period.
Clinical & Coding Specifications
Clinical Context
A Medicare beneficiary enrolled in the Medicare Diabetes Prevention Program (MDPP) expanded model attends two MDPP core maintenance sessions (each approximately one hour) during months 10–12 of the MDPP services period. The sessions use a CDC-approved DPP maintenance curriculum and are furnished by an MDPP supplier (typically a trained lifestyle coach or allied health professional) in an in-person group setting at a community health center or outpatient clinic. During one of the in-person sessions in months 10–12, the coach documents an in-person weight measurement showing that the beneficiary has not achieved at least 5% weight loss from baseline. Session documentation includes attendance, curriculum topic covered (maintenance-focused behavioral strategies), an in-person weight, blood pressure as indicated, and goals for ongoing self-management. Typical workflow: beneficiary schedules/attends scheduled group maintenance sessions; staff register attendance and collect vitals/weight in-person; lifestyle coach delivers the maintenance curriculum and records participation; supplier bills Medicare using G9877 for the two core maintenance sessions in months 10–12 with appropriate modifier(s) as required by payer rules.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Standard primary procedure/service | Use when no special modifier applies and service is billed as primary MDPP maintenance session. |