The Medicare Diabetes Prevention Program expanded model is a structured intervention with the goal of preventing type 2 diabetes in individuals with an indication of prediabetes. The clinical intervention consists of 16 intensive core sessions of a Centers for Disease Control and Prevention (CDC) approved curriculum and through the National Diabetes Prevention Program or National DPP) that provides practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control.

The sessions are furnished weekly over six months in a group-based, classroom-style setting or in a virtual distance learning setting. After completing these core sessions, six less-intensive follow-up meetings, furnished monthly over the next six months, help ensure that participants maintain healthy behaviors. Suppliers may offer and patients may attend more than 22 sessions; however, Medicare only allows up to 22 MDPP sessions per eligible patient.

CY 2026 Updates

• Update weight collection requirements to allow beneficiaries self-reporting weight from home or a reasonable location (e.g., fitness centers, medical facilities, and temporary abodes)
  • Allow weight submission collected and dated within five days of scheduled MDPP session
• Extend flexibilities allowed during COVID-19 PHE through December 31, 2027, including distance learning delivery option for some or all MDPP sessions
  • Not required to maintain in-person delivery capability with program ability delivered asynchronously
  • Allows virtual-only organizations to enroll as MDPP and streamline process allowing greater asynchronous delivery
  • Removes MDPP requirement for interim preliminary recognition and replace with CDC preliminary recognition
• Change Request (CR) 14162 does not allow same-day makeup sessions for G9871.
• Noridian has free stand-alone billing free software for MDPP claims called PC-ACE. This CMS tutorial provides step-by-step guidance for MDPP on how to submit fee-for-service claims for MDPP services
  • New CMS Video Tutorial: MDPP Claims Submission using PC-ACE

Access MDPP-related information from this page below:

• MDPP Overview
• Eligible Beneficiaries
• Supplier Enrollment
• Sessions and Reimbursement
• Billing
• Documentation

MDPP Overview

• One-year program with valid claims billing under MDPP
• Must have both CDC and Medicare separate enrollment
• Once per lifetime set of services per beneficiary
• Submit claims when beneficiary performance goal met
• List HCPCS code with corresponding session date of service and coach's National Provider Identifier (NPI)
• Must include 82 in Block 19 or electronic Loop 2300 Segment REF01 (P4) and Segment REF02 (82) to identify MDPP services
• Do not include non-MDPP services on same claim
• MDPP program questions? Contact mdpp@cms.hhs.gov
• MDPP billing and claims? Contact Noridian’s JE or JF Provider Customer Service

Eligible Beneficiaries

All the following criteria must be met to be eligible for this one-time benefit:

• Enrolled in Medicare Part B
• Has body mass index (BMI) of at least 25 (or at least 23 if self-identified as Asian)
  • At first core session, height and weight must be measured in person and used to calculate BMI
• Met one of the following three blood test requirements within 12 months of first core session
  • Hemoglobin A1c test with a value between 5.7 and 6.4%; or
  • Fasting plasma glucose of 110-125 mg/dL; or
  • Two-hour plasma glucose of 140-199 mg/dL (oral glucose tolerance test)
• No previous type 1 or type 2 diabetes diagnosis (other than gestational diabetes)
  • If beneficiary develops diabetes while receiving MDPP services, s/he may continue with program
• Does not have End Stage Renal Disease (ESRD)
• Physician's referral not required

Supplier Enrollment

Must have both CDC and Medicare MDPP separate enrollment:

• Centers for Disease Control and Prevention (CDC) preliminary or full recognition
  • Supplier Fact Sheet and CDC website for more information
• Separate Medicare enrollment as MDPP supplier with exclusive Specialty Type on NPI record:
  • • D1 (in-person )
    • D2 (in-person with distance learning) new 2026
    • D3 (medical genetics and genomics) new 2026
  • Enrollment Fact Sheet and Checklist
• After CDC approved and Medicare enrolled; may see eligible pre-diabetic patients
  • Medicare Diabetes Prevention Program (MDPP) Expanded Model
  • Claims rejected if not separately enrolled
• More information found on MDPP Enrollment webpage

Sessions and Reimbursement

CMS finalized that Medicare Diabetes Prevention Program (MDPP) suppliers continue to offer MDPP services virtually, using distance-learning delivery through December 31, 2027. CMS updated the MDPP payment structure with fee-for-service (FFS) payments for attendance, while maintaining the weight loss performance payments.

Effective January 1, 2026, billed HCPCS reduced to six G codes:

Billing

• Submit one of two new MDPP one-hour G-codes
  • G9886 for group in-person, G9887 for distance learning
• Beneficiaries attend 22 sessions (alone or in combination with other codes) in 12-month timeframe
• Months 1-6: one in-person or distance learning session every week (max 16 sessions)
• Months 7-12: 1 in-person or distance learning session every month (max 6 sessions)
• Must submit claim for 5 percent weight loss (G9880) prior to submitting for the maintenance 5 percent weight loss from baseline in months (G9888)
• Enrolled Specialty D2 bills with HCPCS G9880, G9881, G9888, and G9887
• Enrolled Specialty D3 bills with HCPCS G9871, G9880, and G9881
• Utilize rendering "coach" National Provider Identifier (NPI)
  • Must update rosters when coach leaves or added
• Every MDPP session delivered via distance learning (make-up or regular session) bills G9887
• May append modifier 76 (repeat procedure by same physician) for G9886, G9887, or G9871 to identify same-day make-up session
• Removed Virtual Modifier (VM) after January 1, 2024
• MDPP services and non-MDPP services must be billed on separate claim forms
  • However, may submit multiple MDPP G-codes for same beneficiary, on same claim
• Not recognized – G9890 (bridge one-time payment) after CY 2025

Noridian Medicare Portal (NMP) offers MDPP details within "Eligibility" inquiry results:

• MDPP Active Period
• MDPP Inactive Period
• NMP Eligibility Details:
  • Medicare Beneficiary Demographics
  • Date of Death
  • Unlawful Occurrences
  • Medicare Part B Entitlement
  • MDPP Coverage
  • MDPP Financial Information
  • End Stage Renal Disease (ESRD)
  • Medicare Advantage Enrollment(s)
  • Medicare as a Secondary Payer (MSP) Enrollment(s)

Documentation

MDPP suppliers must maintain the following electronic or paper records for 10 years following the last day of MDPP beneficiary's receipt of services (certain circumstances may require extension):

• Upon first session, suppliers must record:
  • MDPP supplier name, CDC Diabetic Prevention Recognition Program (DPRP) number, and NPI
  • Beneficiary information includes name, Medicare Beneficiary Identification (MBI) number and age
  • Evidence that each beneficiary meets eligibility requirements
• Upon each additional MDPP session, suppliers must record:
  • Session type (core, core maintenance, or ongoing maintenance); regularly scheduled or make-up (if a make-up, whether virtual or in-person); NPI of coach furnishing session; date and place of session; curriculum topic; and each beneficiary's weight (only required for regularly scheduled sessions)
• When applicable, MDPP supplier records must indicate when an MDPP beneficiary has:
  • Attended core sessions
  • Achieved 5% weight loss
  • Attended core maintenance sessions, has achieved or maintained minimum weight loss, or both
  • Attended two ongoing maintenance sessions and maintained required minimum weight loss
  • Achieved at least 9% weight loss
• Must keep records of certain beneficiary engagement incentives provided to beneficiaries in compliance with Code of Federal Regulations (CFR) 42 CFR 424.210.