Billing Practices for Medicare Diabetes Prevention Program Services

The Centers for Medicare and Medicaid Services (CMS) have expanded its Medicare Diabetes Prevention Program (MDPP) nationwide. Traditional healthcare providers and community-based organizations can enroll as Medicare suppliers of health behavior change services. MDPP model promotes patient centered care. This continues to test market driven reforms to drive quality of care.

According to CMS Administrator Seema Verma, “CMS recognizes that prevention is a critical part of creating an affordable healthcare system that puts patients first, and we encourage eligible suppliers to partner with us on this shared goal by participating in the national expansion of the MDPP.”

Medicare Diabetes Prevention Program

Are you preparing to Enroll as an MDPP Supplier? CMS’ MDPP Billing and Claims Fact Sheet provide guidelines on proper MDPP billing practices and payment rules.

Every claim must be submitted to supplier’s Medicare Administrative Contractors (MACs) directly or to a billing agent. You need to take care of some important information while submitting claim such as:

  • Demo code 82 in block 19 of the CMS-1500 or its electronic equivalent\
  • Appropriate G code(s) with the corresponding session date of service and rendering MDPP coach’s National Provider Identifier (NPI)
  • Virtual modifier VM appended to any G code associated with a session that was furnished as a virtual makeup session as well as MDPP supplier organizational NPI

Certain G-codes that can be used include:

  • G9874 MDPP beneficiary attended a total of 4 MDPP core sessions
  • G9875 MDPP beneficiary attended a total of 9 MDPP core sessions
  • G9876 MDPP beneficiary attended 2 MDPP core maintenance sessions in months 7-9
  • G9877 MDPP beneficiary attended 2 MDPP core maintenance sessions in months 10-12
  • G9878 MDPP beneficiary attended 2 MDPP core maintenance sessions in months 7-9, and achieved the 5% weight loss from his/her baseline weight (Use G9878 or G9876)
  • G9879 MDPP beneficiary attended 2 MDPP core maintenance sessions in months 10-12, and achieved the 5% weight loss from his/her baseline weight (Use G9879 or G9877)

Medisys a professional medical billing company helps physicians to meet complex billing requirement with better accuracy. You can get in touch with us at 302-261-9187 or email us at info@medisysdata.com

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