G9871 Insurance Policy Changes

HCPCS G9871 is officially defined as "Behavioral counseling for diabetes prevention, online, 60 minutes." HCPCS G9871 is referenced in 8 tracked payer policy changes from Michigan Medicaid - MDHHS, Medicare/CMS, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS G9871 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Michigan Medicaid - MDHHS · Effective Jan 1, 2026High impact
MMP 26-03: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates
Michigan Medicaid bulletin MMP 26-03 adopts CPT and HCPCS code changes for Medicaid, Healthy Michigan Plan, Children's Special Health Care Services, Maternity Outpatient Medical Services and MI Coordinated Health programs. Changes effective for dates of service on and after January 1, 2026 include stand-alone vaccine counseling reported under CPT 90482-90484, hearing aid services reported under CPT 92636-92639, psychiatric Collaborative Care Model services reported under CPT 99492-99494 and HCPCS G2214, and activated coverage for CPT 15011-15018 and HCPCS J0681. Coverage of several codes, including V5011, V5020 and G0310-G0315, ended December 31, 2025, and those dates have passed as of the analysis date of 2026-11-05, so this is and current applicability should be checked before acting.
Medicare/CMS · Effective Jan 1, 2026High impact
2026-02-26 - Trump Administration Prioritizes Affordability by Announcing Major Crackdown on Health Care Fraud
CMS announced a major healthcare fraud crackdown including a nationwide moratorium on Medicare enrollment for certain DMEPOS suppliers and enhanced monitoring of MAC MBI lookup tools. Additionally, multiple billing updates are effective including new hypoglossal nerve neurostimulator codes, mandatory electronic CLIA certificates after March 1, and updated therapy service thresholds.
Blue Cross Blue Shield of North Dakota · Effective Jan 1, 2026Medium impact
Diabetes Prevention Program (DPP)
Blue Cross Blue Shield of North Dakota added two new billing codes (G9871 and G9886) for Diabetes Prevention Program services effective January 1, 2026. These codes are for online and in-person group behavioral counseling sessions lasting 60 minutes each.
Independence Blue Cross · Effective Jan 1, 2026Medium impact
MA00.003af, Preventive Care Services
Independence Blue Cross updated MA00.003af to MA00.003ah effective 01/01/2026, implementing CPT and HCPCS code updates for preventive care services. Key changes include: G0136 revised to reflect physical activity and nutrition assessment (rather than social determinants); J2711 added for colorectal cancer screening support; G9871 added for online diabetes prevention counseling; and CPT 90480/90481 updated for COVID-19 vaccine administration. Billing teams must update coding practices to reflect these specific code changes and narrowed/expanded coverage criteria.
Independence Blue Cross · Effective Jan 1, 2026Medium impact
MA00.036l, Telehealth Services
Independence Blue Cross updated telehealth policy MA00.036l to MA00.036n effective 01/01/2026, removing HCPCS code G0071, adding G9871 as eligible for reimbursement, and revising the narrative for G0136. Billing teams must update systems to stop using the terminated code and begin recognizing G9871 for telehealth service reimbursement under Medicare Advantage plans.
Indiana Medicaid (IHCP) · Effective Jan 1, 2026Medium impact
BT2025188: Coverage and billing information for the 2026 annual HCPCS code update
Effective for dates of service on or after January 1, 2026, Indiana Medicaid lists the new CPT, CDT and other HCPCS codes from the 2026 annual HCPCS update as either covered or noncovered, and shows whether each one requires prior authorization or NDC. Codes discontinued in the update are listed with alternate code considerations, and the source states that inclusion of an alternate code does not indicate IHCP coverage of that alternate code. The IHCP is awaiting the final posting of the CMS fee schedules that set pricing for these codes, and reimbursement amounts will be posted on the Professional Fee Schedule and Outpatient Fee Schedule once pricing is established.
Medicare/CMS · Effective Jan 1, 2026Medium impact
2026-02-05 - Hospitals: Submit Data for OPPS Drug Acquisition Cost Survey by March 31
The MLN Connects newsletter for February 5, 2026 announces multiple billing updates including a March 31 deadline for hospitals to submit drug acquisition cost data, elimination of AX modifier requirements for ESRD facilities starting July 2026, and new HCPCS codes for behavioral health integration services effective January 2026.
Medicare/CMS · Identified Apr 23, 2026Medium impact
2026-04-23 - 2026 CMS Interoperability Standards & Prior Authorization Proposed Rule Resources
CMS released new resources for the 2026 Interoperability Standards and Prior Authorization Proposed Rule, with comment period ending June 15. The update includes technical workflows, proposed metrics, and implementation guides for new prior authorization requirements and API standards.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect HCPCS G9871?

There are 8 tracked policy changes affecting HCPCS G9871, including updates from Michigan Medicaid - MDHHS, Medicare/CMS, Blue Cross Blue Shield of North Dakota. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS G9871?

Payers that have issued tracked updates for HCPCS G9871 include: Michigan Medicaid - MDHHS, Medicare/CMS, Blue Cross Blue Shield of North Dakota, Independence Blue Cross, Indiana Medicaid (IHCP).

How do I get notified when HCPCS G9871 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS G9871. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS G9871?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

All billing codes J3590 C9399 J3490 99215 99213 99202

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MMP 26-03: Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates

2026-02-26 - Trump Administration Prioritizes Affordability by Announcing Major Crackdown on Health Care Fraud

Diabetes Prevention Program (DPP)

MA00.003af, Preventive Care Services

MA00.036l, Telehealth Services

BT2025188: Coverage and billing information for the 2026 annual HCPCS code update

2026-02-05 - Hospitals: Submit Data for OPPS Drug Acquisition Cost Survey by March 31

2026-04-23 - 2026 CMS Interoperability Standards & Prior Authorization Proposed Rule Resources

What insurance policy changes affect HCPCS G9871?

Which payers have updated policy for HCPCS G9871?

How do I get notified when HCPCS G9871 policy changes?

Why do payers change policies for HCPCS G9871?