How To Use HCPCS Code G9885

HCPCS code G9885 describes two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions attended by an MDPP beneficiary in months 22-24 under the MDPP Expanded Model (EM). This code is used to identify ongoing maintenance sessions that are provided by an MDPP supplier during months 13 through 24 of the MDPP services period. These sessions are approximately 1 hour in length and adhere to a CDC-approved DPP curriculum for maintenance sessions. The beneficiary must have maintained at least 5% weight loss from their baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 22-24.

1. What is HCPCS G9885?

HCPCS code G9885 is a specific code used to identify two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions attended by an MDPP beneficiary in months 22-24 under the MDPP Expanded Model (EM). It is important to use this code accurately to ensure proper documentation and billing for these services.

2. Official Description

The official description of HCPCS code G9885 is as follows: “Two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 22-24 under the MDPP Expanded Model (EM). An ongoing maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 13 through 24 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 maintained at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at an ongoing maintenance session in months 22-24.”

3. Procedure

1. The MDPP supplier schedules two ongoing maintenance sessions for the beneficiary in months 22-24.
2. Each ongoing maintenance session is approximately 1 hour in length.
3. The sessions adhere to a CDC-approved DPP curriculum for maintenance sessions.
4. During the sessions, the beneficiary’s weight is measured in-person to ensure they have maintained at least 5% weight loss from their baseline weight.

4. When to use HCPCS code G9885

HCPCS code G9885 should be used when documenting and billing for two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions attended by an MDPP beneficiary in months 22-24 under the MDPP Expanded Model (EM). It is important to ensure that the beneficiary has met the eligibility criteria, including maintaining at least 5% weight loss from their baseline weight.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9885, healthcare providers need to document the following:

• Confirmation that the beneficiary attended two ongoing maintenance sessions in months 22-24.
• Documentation of the duration of each session, which should be approximately 1 hour.
• Evidence that the sessions adhered to a CDC-approved DPP curriculum for maintenance sessions.
• In-person weight measurements during the sessions to confirm at least 5% weight loss from the beneficiary’s baseline weight.

6. Historical Information and Code Maintenance

HCPCS code G9885 was added to the Healthcare Common Procedure Coding System on April 01, 2018. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

The coverage for HCPCS code G9885 is determined by carrier judgment (Coverage Code C). The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. It is important to check with Medicare or other insurers to determine the specific coverage and pricing for this code.

8. Examples

Here are five examples of when HCPCS code G9885 should be billed:

1. A Medicare beneficiary attends two ongoing maintenance sessions in months 22-24 under the MDPP Expanded Model (EM) and has maintained at least 5% weight loss from their baseline weight.
2. An MDPP supplier provides two ongoing maintenance sessions to a beneficiary in months 22-24, following a CDC-approved DPP curriculum, and confirms at least 5% weight loss from the baseline weight.
3. A healthcare provider documents and bills for two ongoing maintenance sessions attended by a beneficiary in months 22-24 under the MDPP Expanded Model (EM), ensuring adherence to a CDC-approved DPP curriculum and at least 5% weight loss from the baseline weight.
4. A Medicare beneficiary receives two ongoing maintenance sessions in months 22-24 as part of the MDPP services, meeting the eligibility criteria and maintaining at least 5% weight loss from their baseline weight.
5. An MDPP supplier provides two ongoing maintenance sessions to a beneficiary in months 22-24, following the MDPP guidelines and confirming at least 5% weight loss from the baseline weight.