CMS has released the 2020 payment rates for HCPCS codes for the Medicare Diabetes Prevention Program (MDPP). A provider can receive payments of varying amounts close to $700 per beneficiary.
New MDPP 2020 payment rates go into effect Jan. 1. While the rate change is minimal, every dollar makes a difference towards an ounce of prevention.
Payments are spread out over the course of two years and are dependent on the beneficiary’s attendance and weight loss.
The annual rate increase is based on the percent change in the Consumer Price Index for All Urban Consumers (CPI-U) (U.S. city average) for the 12-month period ending June 30, 2019.
The Medicare Diabetes Prevention Program assists Medicare beneficiaries who present with prediabetes from progressing into the full-blown disease. Diabetes is associated with other significant health problems such as heart and kidney disease and neuropathy, whose treatment costs are significant.
The MDPP’s goal is to reduce Medicare’s financial burden in treating diabetes and related conditions, by preventing it in the first place.
Stack Up HCPCS G-Codes to Report Medicare Diabetes Prevention Program
Medicare Diabetes Prevention Program MDPP suppliers use HCPCS G-codes to bill for MDPP services. For the 2020 MDPP, here are the HCPCS G-codes and payment amounts: 
*Specific performance goals for attendance and weight loss must be met at the end of each interval for the beneficiary to be eligible to advance into the next interval and continue receiving services. Also, 5% weight loss and attendance must be achieved in order to receive payment during these ongoing maintenance sessions.
Review Diabetes Prevention Program Core, Maintenance Sessions
The CDC estimates 84 million adults have prediabetes including 23 million aged 65 years or older. The Medicare Diabetes Prevention Program, which began enrollment in January 2018, is a lifestyle change program helping to reverse this progression to diabetes.
The program offers diabetes prevention care to prediabetic beneficiaries with the goal of preventing or reducing the onset of type 2 diabetes.
During the program — which focuses on reducing stress, increasing physical activity, and encouraging diet modifications — beneficiaries are guided through 16 weekly core sessions for the first six months and then monthly core maintenance sessions for the next six months. These sessions are guaranteed to the beneficiary regardless of weight loss.
Beyond the first year, beneficiaries who have achieved and maintain a minimum of 5 percent weight loss are eligible for additional monthly maintenance sessions. The CMS diabetes prevention program offers:
- Classroom-based instruction with CDC-approved curriculum, providing beneficiaries the necessary resources to make healthy lifestyle changes.
- An encouraging coach — who is a trained community health worker or health professional — to lead the training sessions and help beneficiaries set and meet lifestyle change goals.
- A peer support group for beneficiaries to share goals, challenges, and successes.
Meet Eligibility Requirements for Medicare Diabetes Prevention Program To be eligible for MDPP, a beneficiary must:
- Be enrolled in Medicare Part B
- Have a body mass index (BMI) of at least 25 (or at least 23 if self-identified as Asian)
- Meet 1 of the following 3 blood test requirements within the 12 months of the first core session:
- Hemoglobin A1c test with a value between 5.7 and 6.4%
- Fasting plasma glucose of 110-125 mg/dL
- 2-hour oral glucose tolerance test of 140-199 mg/dL
- Not have a previous diagnosis of type 1 or type 2 diabetes (other than gestational diabetes)
- Not have an end-stage renal disease (ESRD)
Commonly Purchased Online Trainings and Resources
