HCPCS G9881: MDPP 9% Weight Loss Achievement

HCPCS Level II code G9881 indicates a one-time payment under the Medicare Diabetes Prevention Program (MDPP) expanded model when a beneficiary achieves at least 9% weight loss from baseline as verified by an in-person weight measurement during a core, core maintenance, or ongoing maintenance session; service type: behavioral weight-loss outcome reporting within a structured MDPP program; typical site of service: in-person MDPP group or individual session held at a clinic, community center, or accredited MDPP delivery site.

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HCPCS G9881: MDPP 9% Weight Loss Achievement

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Get alerted when payer policies referencing G9881 are released or updated.

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Clinical & Coding Specifications

Clinical Context

A Medicare Diabetes Prevention Program (MDPP) Expanded Model one-time achievement payment G9881 applies when a beneficiary first attains at least 9% weight loss from baseline, measured in person at a core, core maintenance, or ongoing maintenance session within months 1–24. A typical patient is a 62-year-old with prediabetes enrolled in the MDPP-Expanded Model. The beneficiary attends regular in-person group or individual core sessions during the first 6 months and periodic maintenance sessions thereafter. Baseline weight is recorded at program enrollment. Over successive core sessions the beneficiary implements lifestyle and dietary changes, and at a scheduled core or maintenance visit an in-person weight measurement documents a 9.2% reduction from baseline. The MDPP coordinator documents the measured weight, calculates percent weight change, confirms this is the first time ≥9% is achieved within months 1–24, and submits a one-time claim for G9881.

Clinical workflow:

Referral or self-enrollment of eligible Medicare beneficiary into MDPP-Expanded Model.
Initial intake visit: obtain baseline weight, height, BMI, medical history, and set goals; document baseline weight in the clinical record.
Delivery of core sessions (group or individual), with periodic in-person weight measurements at scheduled core sessions.
Maintenance sessions (core maintenance or ongoing maintenance) with in-person weigh-ins to monitor progress.
When an in-person weight measurement at a core, core maintenance, or ongoing maintenance session shows ≥9% weight loss from baseline within months 1–24, the MDPP provider documents the session, the measured weight, the percent change calculation, and that this is the beneficiary’s first attainment of ≥9%.
Billing staff appends appropriate billing modifiers and submits a one-time claim for G9881 to the beneficiary’s Medicare Administrative Contractor; supporting documentation (session note, measured weight, and calculation) is retained in the beneficiary record.

Related CPT Codes

When CPT crosswalks are needed for ancillary or related clinical services, common codes used alongside MDPP in-person sessions include basic office/outpatient evaluation and measurement and separately reported counseling services.

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	May be used when an MDPP beneficiary has a shorter established-patient E/M visit during which the in-person weight measurement and counseling are performed and medically necessary E/M elements are documented.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Used when a more complex established-patient visit occurs with significant medical decision making or prolonged counseling including documented weight measurement and management planning.
`99401`	Preventive medicine counseling, individual, approximately 15 minutes (historical; CPT 99401-99404 deleted 2013)	Historically used for preventive counseling; modern MDPP counseling is typically not billed under these codes but under program-specific or bundled arrangements—include for historical workflow recognition.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, 3–10 minutes	Example of a behavioral counseling CPT that may be billed for concurrent counseling services provided during an MDPP session if separately reportable and meeting requirements.
`G0447`	Face-to-face behavioral counseling for obesity, 15 minutes	Commonly used Medicare G-code for obesity counseling in some workflows; may be reported for structured counseling visits provided in addition to program MDPP session documentation when all billing rules are met.

Related Modifiers

7 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
1835P0200X	Pediatric Pharmacist	A licensed pharmacist who has demonstrated specialized knowledge and skill in the delivery of patient care services by pharmacists that ensures the sa…
103T00000X	Psychologist	A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, a…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	A specialist who treats decompression illness and diving accident cases and uses hyperbaric oxygen therapy to treat such conditions as carbon monoxide…
224ZF0002X	Feeding, Eating & Swallowing Occupational Therapy Assistant	Occupational therapy assistants provide environmental modifications under the supervision of an occupational therapist. OTAs develop and implement an…
2085N0700X	Neuroradiology Physician	A radiologist who diagnoses and treats diseases utilizing imaging procedures as they relate to the brain, spine and spinal cord, head, neck and organs…
3418M1120X	Military or U.S. Coast Guard Air Transport Ambulance	Vehicle and staff for patient emergency or non-emergency air transport.

Related ICD-10-CM Codes

20 rows

ICD-10-CM Code	Description
E03.9	Hypothyroidism, unspecified
E11.65	Type 2 diabetes mellitus with hyperglycemia
E11.9	Type 2 diabetes mellitus without complications
E66.01	Morbid (severe) obesity due to excess calories
E66.3	Overweight
E66.9	Obesity, unspecified
E78.2	Mixed hyperlipidemia
E78.5	Hyperlipidemia, unspecified
F32.9	Major depressive disorder, single episode, unspecified
F41.9	Anxiety disorder, unspecified

Showing 1–10 of 20

HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Administration of Influenza Virus Vaccine

HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

HCPCS G0009: Administration of Pneumococcal Vaccine

HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

HCPCS G0010: Administration of Hepatitis B Vaccine

HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

HCPCS G0012: Injection of PrEP Drug for HIV Prevention

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling by Clinical Staff

HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

HCPCS G0019: Community Health Integration, Person-Centered Assessment

Showing 1–10 of 1996

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Clinical workflow:

Referral or self-enrollment of eligible Medicare beneficiary into MDPP-Expanded Model.
Initial intake visit: obtain baseline weight, height, BMI, medical history, and set goals; document baseline weight in the clinical record.
Delivery of core sessions (group or individual), with periodic in-person weight measurements at scheduled core sessions.
Maintenance sessions (core maintenance or ongoing maintenance) with in-person weigh-ins to monitor progress.
When an in-person weight measurement at a core, core maintenance, or ongoing maintenance session shows ≥9% weight loss from baseline within months 1–24, the MDPP provider documents the session, the measured weight, the percent change calculation, and that this is the beneficiary’s first attainment of ≥9%.
Billing staff appends appropriate billing modifiers and submits a one-time claim for G9881 to the beneficiary’s Medicare Administrative Contractor; supporting documentation (session note, measured weight, and calculation) is retained in the beneficiary record.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	May be used when an MDPP beneficiary has a shorter established-patient E/M visit during which the in-person weight measurement and counseling are performed and medically necessary E/M elements are documented.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Used when a more complex established-patient visit occurs with significant medical decision making or prolonged counseling including documented weight measurement and management planning.
`99401`	Preventive medicine counseling, individual, approximately 15 minutes (historical; CPT 99401-99404 deleted 2013)	Historically used for preventive counseling; modern MDPP counseling is typically not billed under these codes but under program-specific or bundled arrangements—include for historical workflow recognition.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, 3–10 minutes	Example of a behavioral counseling CPT that may be billed for concurrent counseling services provided during an MDPP session if separately reportable and meeting requirements.
`G0447`	Face-to-face behavioral counseling for obesity, 15 minutes	Commonly used Medicare G-code for obesity counseling in some workflows; may be reported for structured counseling visits provided in addition to program MDPP session documentation when all billing rules are met.

Related Modifiers

7 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
1835P0200X	Pediatric Pharmacist	A licensed pharmacist who has demonstrated specialized knowledge and skill in the delivery of patient care services by pharmacists that ensures the sa…
103T00000X	Psychologist	A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, a…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	A specialist who treats decompression illness and diving accident cases and uses hyperbaric oxygen therapy to treat such conditions as carbon monoxide…
224ZF0002X	Feeding, Eating & Swallowing Occupational Therapy Assistant	Occupational therapy assistants provide environmental modifications under the supervision of an occupational therapist. OTAs develop and implement an…
2085N0700X	Neuroradiology Physician	A radiologist who diagnoses and treats diseases utilizing imaging procedures as they relate to the brain, spine and spinal cord, head, neck and organs…
3418M1120X	Military or U.S. Coast Guard Air Transport Ambulance	Vehicle and staff for patient emergency or non-emergency air transport.

Related ICD-10-CM Codes

20 rows

ICD-10-CM Code	Description
E03.9	Hypothyroidism, unspecified
E11.65	Type 2 diabetes mellitus with hyperglycemia
E11.9	Type 2 diabetes mellitus without complications
E66.01	Morbid (severe) obesity due to excess calories
E66.3	Overweight
E66.9	Obesity, unspecified
E78.2	Mixed hyperlipidemia
E78.5	Hyperlipidemia, unspecified
F32.9	Major depressive disorder, single episode, unspecified
F41.9	Anxiety disorder, unspecified

Showing 1–10 of 20

HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Administration of Influenza Virus Vaccine

HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

HCPCS G0009: Administration of Pneumococcal Vaccine

HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

HCPCS G0010: Administration of Hepatitis B Vaccine

HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

HCPCS G0012: Injection of PrEP Drug for HIV Prevention

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling by Clinical Staff

HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

HCPCS G0019: Community Health Integration, Person-Centered Assessment

Showing 1–10 of 1996

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

HCPCS G9881: MDPP 9% Weight Loss Achievement

Sign up for hcpcs G9881 policy alerts

OpenPayer

HCPCS G9881: MDPP 9% Weight Loss Achievement

Sign up for hcpcs G9881 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

HCPCS G9881: MDPP 9% Weight Loss Achievement

Sign up for hcpcs G9881 policy alerts

HCPCS G9881: MDPP 9% Weight Loss Achievement

Sign up for hcpcs G9881 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What clinical event does HCPCS code G9881 describe?

Where and how must the ≥9% weight loss be documented to support a G9881 claim?

Can G9881 be billed more than once for the same beneficiary if they later meet the 9% threshold again?

Which billing modifiers are appropriate or commonly relevant when submitting a G9881 claim?

Which provider specialties or taxonomies commonly deliver MDPP services related to the G9881 milestone?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What clinical event does HCPCS code G9881 describe?

Where and how must the ≥9% weight loss be documented to support a G9881 claim?

Can G9881 be billed more than once for the same beneficiary if they later meet the 9% threshold again?

Which billing modifiers are appropriate or commonly relevant when submitting a G9881 claim?

Which provider specialties or taxonomies commonly deliver MDPP services related to the G9881 milestone?

References