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See a sample rate comparisonHCPCS G9881 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
The MDPP beneficiary achieved at least 9% weight loss (WL) from his/her baseline weight in months 1-24 under the MDPP Expanded Model (EM). This is a one-time payment available when a beneficiary first achieves at least 9% weight loss from baseline as measured by an in-person weight measurement at a core session, core maintenance session, or ongoing maintenance session.
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Additional Assorted Quality Measures |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for G9881 |
National average reimbursement for HCPCS G9881 by major payers:
$33.06
$32.31
$29.20
$25.21
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HCPCS G9881
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
$58.75Published rateApril Leuzinger
Aztec Urgent Care LLC
$45.54Published rateCarolina Radiology Associates LLC
Carolina Radiology Associates, LLC
$32.50Published rateTexas Radiology Associates LLP
Texas Radiology Associates, LLP
$27.50Published rateMarc Stiefel
Pinnacle Ent Alliance, LLC
$21.25Published rate
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See a sample payer proposalHCPCS G9881 vs. Other Additional Assorted Quality Measures Codes
The HCPCS G9881 code is part of the Procedures / Professional Services services used for Additional Assorted Quality Measures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS G9881 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| G9880-HCPCS | Moderate | The MDPP beneficiary achieved at least 5% weight loss (WL) from his/her baseline weight in months 1-12 of the MDPP services period under the MDPP Expanded Model (EM). This is a one-time payment available when a beneficiary first achieves at least 5% weight loss from baseline as measured by an in-person weight measurement at a core session or core maintenance session. |
| G9881-HCPCS | Low | The MDPP beneficiary achieved at least 9% weight loss (WL) from his/her baseline weight in months 1-24 under the MDPP Expanded Model (EM). This is a one-time payment available when a beneficiary first achieves at least 9% weight loss from baseline as measured by an in-person weight measurement at a core session, core maintenance session, or ongoing maintenance session. |
| G9882-HCPCS | Low | Two Medicare Diabetes Prevention Program (MDPP) ongoing maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 13-15 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 13-15. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G9881. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G9881 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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