Summary & Overview
HCPCS G9890: MDPP One-Time Bridge Payment for Session Transition
HCPCS Level II code G9890 designates a one-time bridge payment for transitions between Medicare Diabetes Prevention Program (MDPP) suppliers. It applies when an MDPP supplier delivers the first core, a core maintenance, or an ongoing maintenance session during months 1–24 of the MDPP expanded model to a beneficiary who previously received MDPP services from a different supplier. The code is limited to a single bridge payment per beneficiary and supports continuity of care during supplier changes. Nationally, this code matters as Medicare seeks to preserve access and encourage continuity in the MDPP expanded model while limiting duplicate payments.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise guidance on the clinical and billing context for G9890, summaries of payer coverage considerations, and notes on program design implications. The publication summarizes what the code represents, where it fits within MDPP delivery (core and maintenance sessions), and which stakeholders are affected. Benchmarks, policy updates, and payer-specific coverage details are outlined to help billing managers, compliance officers, and program administrators understand how G9890 functions within national MDPP reimbursement and supplier workflows.
Billing Code Overview
HCPCS Level II code G9890 is a one-time bridge payment for the Medicare Diabetes Prevention Program (MDPP) expanded model. The code applies when an MDPP supplier furnishes the first core session, a core maintenance session, or an ongoing maintenance session to an MDPP beneficiary during months 1–24 of the expanded model who previously received MDPP services from a different MDPP supplier. A supplier may receive only one bridge payment per MDPP beneficiary.
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Service type: Payment for MDPP session transition support (bridge payment)
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Typical site of service: Services are furnished by an MDPP supplier and may occur in community or outpatient settings where MDPP suppliers provide core or maintenance sessions.
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Clinical & Coding Specifications
Clinical Context
A 62-year-old Medicare beneficiary previously enrolled in the Medicare Diabetes Prevention Program (MDPP) Expanded Model (EM) with Supplier A transfers care to Supplier B at month 10. The beneficiary has completed some MDPP sessions with Supplier A and now attends a first MDPP core session with Supplier B. Supplier B bills a one-time bridge payment for the first MDPP session furnished to a beneficiary who previously received MDPP services from a different MDPP supplier during months 1–24 of the MDPP EM.
A typical clinical workflow: the beneficiary contacts the new MDPP supplier, completes intake and eligibility verification, and the supplier documents prior MDPP participation with Supplier A. The supplier furnishes the appropriate MDPP core, core maintenance, or ongoing maintenance session and documents the session date, content, and evidence of prior supplier participation. The supplier submits claim for the one-time bridge payment using HCPCS code G9890, including any applicable modifier(s) to indicate circumstances such as unusual procedural service or billing scenario, and retains documentation showing the beneficiary previously received MDPP services from a different MDPP EM supplier. The supplier may receive only one G9890 payment per beneficiary.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
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