G9876 HCPCS code: Two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9
G9876 is the HCPCS Level II code for two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9. In 2023 Medicare paid an average of $59.59 per service for G9876 across 183 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. Medicare volume rose 66% from 2022 to 2023 (110 to 183 services). In 2023, about 57 clinicians billed Medicare for G9876 for 183 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | Y1 |
| Added | 2018-04-01 |
| Last action effective | 2018-04-01 |
Who bills G9876 (2023)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 57 |
| Medicare beneficiaries | 183 |
| States with claims | 4 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G9876, 2022–2023
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 110 | 110 | $52.67 | $52.67 |
| 2023 | 183 | 183 | $59.59 | $59.59 |
States with the most G9876 services (2023)
| State | Services | Avg. paid |
|---|---|---|
| Oregon | 19 | $74.48 |
| Michigan | 18 | $74.48 |
| South Carolina | 17 | $62.78 |
| Wisconsin | 11 | $31.00 |
What changed for G9876
- 2018-04-01: G9876 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G9876?
G9876 is the HCPCS Level II code for two medicare diabetes prevention program (mdpp) core maintenance sessions (ms) were attended by an mdpp beneficiary in months (mo) 7-9 under the mdpp expanded model (em). a core maintenance session is an mdpp service that: (1) is furnished by an mdpp supplier during months 7 through 12 of the mdpp services period; (2) is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for maintenance sessions. the beneficiary did not achieve at least 5% weight loss (wl) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9. Short descriptor: "2 em core ms mo 7-9 no wl".
How much does Medicare pay for G9876?
In 2023, the average Medicare payment was $59.59 per service (average allowed $59.59).
Does Medicare cover G9876?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G98 codes
- G9800 — Patients who are identified as having an intolerance or allergy to beta-blocker therapy
- G9801 — Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis
- G9802 — Patients who use hospice services any time during the measurement period
- G9803 — Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
- G9804 — Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
- G9805 — Patients who use hospice services any time during the measurement period
- G9806 — Patients who received cervical cytology or an hpv test
- G9807 — Patients who did not receive cervical cytology or an hpv test
- G9808 — Any patients who had no asthma controller medications dispensed during the measurement year
- G9809 — Patients who use hospice services any time during the measurement period
- G9810 — Patient achieved a pdc of at least 75% for their asthma controller medication
- G9811 — Patient did not achieve a pdc of at least 75% for their asthma controller medication
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under G9876
- Watch G9876 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G9876
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.