Medicare Diabetes Prevention Program

Since April 2018 Medicare beneficiaries with prediabetes who also have elevated body mass indices (≥ 25 kg/m2 and ≥ 23 kg/m2 in Asian populations) have a benefit with coverage for diabetes prevention services. The coverage is for a year of in-person structured health behavior change sessions (set of services) that use an approved curriculum from the Centers for Disease Control and Prevention. The services can only be provided by programs that are approved Medicare suppliers of the Medicare Diabetes Prevention Program

The MDPP provides opportunities for nutrition and dietetics practitioners to play an important role in diabetes prevention in the Medicare population in health care and community settings. There are various roles for nutrition and dietetics practitioners. The following pages are designed to help you understand the training requirements for MDPP lifestyle coaches, opportunities to integrate MDPP services into the continuum of care for diabetes and increase referrals for Medical Nutrition Therapy and other services, and requirements for becoming a Medicare supplier.

Many private payers already cover diabetes prevention services. The payment methodology, billing codes, and requirements are different for the MDPP.

Medicare uses an Alternative Payment Model that is a performance-based payment methodology for the MDPP services. There are fifteen G codes for the MDPP as well as attendance and weight loss benchmarks to earn maximum payments from the Centers for Medicare and Medicaid Services.

The CDC created the National Diabetes Prevention Program based on the results of the Diabetes Prevention Program Randomized Control Trial. The Centers for Medicare and Medicaid Innovation conducted a DPP model test that demonstrated cost effective risk reduction when lay health workers delivered the CDC-approved curriculum in YMCAs. CMS projects that the MDPP Expanded Model will save $182 million over ten years.

The CDC and CMS are working closely to operationalize the new benefit for Medicare beneficiaries. Each entity has different roles in the MDPP.

MDPP Webinar Resources

National Diabetes Prevention Program