Question 1

What is HCPCS code G9874?

Accepted Answer

HCPCS code G9874 is "4 em core sessions". Four total medicare diabetes prevention program (mdpp) core sessions were attended by an mdpp beneficiary under the mdpp expanded model (em).  a core session is an mdpp service that: (1)  is furnished by an mdpp supplier during months 1 through 6 of the mdpp services period; (2)  is approximately 1 hour in length; and (3) adheres to a cdc-approved dpp curriculum for core sessions

Question 2

What category is G9874 in?

Accepted Answer

G9874 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9874?

Accepted Answer

Use G9874 when billing for 4 em core sessions. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G9874 covered by Medicare?

Accepted Answer

Coverage for G9874 (4 em core sessions) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G9874?

Accepted Answer

Documentation for G9874 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).