Pre-Diabetes Services: Referring Patients to the Medicare Diabetes Prevention Program

MLN Matters Number: SE19001
Article Release Date: June 27, 2019

MDPP is a Behavior Change Intervention:

  • An estimated half of all adults age 65 and older have pre-diabetes. The MDPP is an evidence-based, structured behavior change intervention to prevent or delay type 2 diabetes in individuals with an indication of pre-diabetes.
  • The primary goal of MDPP services is to help individuals lose at least 5 percent of their weight, which is associated with a clinically significant reduction in risk for type 2 diabetes. When studied, this intervention reduced the incidence of diabetes by 71 percent in individuals over age 60.

MDPP is a New Medicare-Covered Service:

  • MDPP suppliers began enrolling in Medicare in January 2018 and Medicare began paying for MDPP services on April 1, 2018.
  • Both traditional health care providers and community-based organizations can enroll as MDPP suppliers (a new Medicare supplier type) to provide MDPP services.
  • Screen, test, and refer. You can screen and test your patients' risk for pre-diabetes and refer your patients to a Medicare-enrolled MDPP supplier. Medicare doesn't require providers' referral for MDPP services, but your patients may want to discuss MDPP services with you.
  • There is no co-pay or deductible for MDPP services for patients who have Medicare Part B (Fee-For-Service) and meet other eligibility criteria. Patients in a Medicare Advantage plan can contact their plan for cost-sharing information.

View the complete CMS Medicare Learning Network (MLN) Matters (MM) Special Edition (SE)19001.

            Last Updated Thu, 11 Jul 2019 09:55:53 +0000