Summary & Overview
HCPCS G9878: MDPP Core Maintenance — Two Sessions, Months 7–9, ≥5% Weight Loss
HCPCS Level II code G9878 documents two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions attended by a beneficiary in months 7–9 of the MDPP services period, with the beneficiary achieving at least 5% weight loss from baseline as measured in-person. This code captures a defined maintenance-phase service within the MDPP Expanded Model and is used to recognize continued engagement and clinically meaningful weight loss during months 7–9. Nationally, accurate use of G9878 matters for consistent reporting of MDPP outcomes, program continuity, and for tracking beneficiary adherence to maintenance-phase interventions that support long-term risk reduction for type 2 diabetes.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical and programmatic context for G9878, how it fits into the MDPP service timeline, and which services and settings it represents. The publication also outlines common modifiers associated with MDPP procedural reporting, summarizes typical sites of service, and indicates where input data are not available. This briefing is intended to help billing, compliance, and program staff understand the code's clinical intent, documentation expectations implied by the description, and its role in national MDPP reporting and reimbursement workflows.
Billing Code Overview
HCPCS Level II code G9878 describes 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 7–12 of the MDPP services period, is approximately one hour in length, and adheres to a CDC-approved DPP curriculum for maintenance sessions. The description specifies that the beneficiary achieved at least 5% weight loss from baseline, as measured by at least one in-person weight measurement at a core maintenance session in months 7–9.
Service type: MDPP core maintenance sessions (group or individual MDPP maintenance counseling sessions as defined by the program).
Typical site of service: MDPP supplier location or other in-person site where MDPP maintenance sessions are delivered.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old Medicare beneficiary with prediabetes enrolls in the Medicare Diabetes Prevention Program (MDPP) Expanded Model. After completing the initial 6-month core curriculum, the beneficiary attends maintenance services in months 7–9. During two separate in-person core maintenance sessions, each approximately one hour in length and following a CDC-approved DPP maintenance curriculum, the beneficiary’s weight is measured. At one of these sessions the beneficiary demonstrates a sustained weight reduction of at least 5% from baseline, confirmed by the in-person measurement. The clinical workflow includes appointment scheduling by the MDPP supplier, documentation of attendance and session content, in-person weight measurement and BMI calculation, tracking of cumulative weight loss relative to baseline, and submission of claims using HCPCS Level II code G9878 for the two core maintenance sessions attended in months 7–9 under the MDPP Expanded Model. Typical encounter notes contain session date/time, duration (~60 minutes), curriculum adherence, measured weight and percent weight loss from baseline, beneficiary identifier, and supplier credentials.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (standard) | Use when no special circumstances apply and the service is billed routinely. |