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Medicare Diabetes Prevention Program

 

Diabetes Prevention

Do you have patients who are at risk for diabetes?

 

They may be eligible to enroll in the Medicare Diabetes Prevention Program (MDPP). Patients in the program can reduce their risk of diabetes through lifestyle support and coaching for up to two years at no cost.

 

Learn more. Visit the Centers for Medicare & Medicaid Services (CMS) website.

 

Who's eligible?

Your HMSA Akamai Advantage® or Essential Advantage patients who meet the following criteria:

 

Find a Centers for Disease Control and Prevention (CDC) accredited program

Visit the CDC website.

 

Hawaii Department of Health resources

Visit the state DOH website for a sample referral form and more information.

 

Interested in being an MDPP service provider?

Register with the CDC and CMS. Get started using the MDPP Orientation Roadmap.

 

Want to join HMSA's provider network?

Visit the HMSA Provider Resource Center.

 

Already an HMSA provider?

Call HMSA Provider Services to register as an MDPP provider at 948-6820 on Oahu or 1 (877) 304-4672 toll-free on the Neighbor Islands.

 

Coding MDPP Services

HCPCS

G-code

Description of Service
G9873 1st core session attended
G9874 4 total core sessions attended
G9875 9 total core sessions attended
G9876 2 core maintenance sessions attended in months 7-9 (weight loss goal not achieved or maintained)
G9877 2 core maintenance sessions attended in months 10-12 (weight loss goal not achieved or maintained)
G9878 2 core maintenance sessions attended in months 7-9 and weight loss goal achieved or maintained
G9879 2 core maintenance sessions attended in months 10-12 and weight loss goal achieved or maintained
G9880 5 percent weight loss from baseline achieved
G9881 9 percent weight loss from baseline achieved
G9882 2 ongoing maintenance sessions attended in months 13-15 and weight loss goal maintained
G9883 2 ongoing maintenance sessions attended in months 16-18 and weight loss goal maintained
G9884 2 ongoing maintenance sessions attended in months 19-21 and weight loss goal maintained
G9885 2 ongoing maintenance sessions attended in months 22-24 and weight loss goal maintained
G9890 Bridge payment - First session furnished by MDPP supplier to an MDPP beneficiary who previously received MDPP services from a different MDPP supplier
G9891 MDPP session reported as a line item on a claim for a payable MDPP service HCPCS G-code for a session furnished by the billing supplier that counts toward achievement of the attendance performance goal for the payable MDPP services HCPCS G-code

 

 

Billing MDPP services

 

For example, a claim for G9874 would include four service lines with appropriate dates of service. G9874 is billed with the service date for the most recent class. To prevent processing delays, please don't submit payable codes with different "from" and "to" dates.

 

Since G9874 indicates four total classes have been completed, three G9891 codes must be included on the claim, each with a specific service date. The first class in the series would have been billed earlier using G9873.

 

HCPC Code DOS from DOS to
G9874

5/29/2018

5/29/2018

G9891

5/1/2018

5/1/2018

G9891

5/16/2018

5/16/2018

G9891

5/29/2018

5/29/2018

 

A few reminders

 

First Published:03/16/2018

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