CMS Has Made Improvements to the Medicare Diabetes Prevention Program
The Medicare
Diabetes Prevention Program (MDPP) is an
example of evidence-based Lifestyle Medicine (LM)
methods that are being used to prevent and delay
type 2 diabetes. And for 2024, CMS made changes to
the MDPP to make the MDPP easier to navigate by
the providers, more flexible, and more effective.
After receiving much criticism concerning the
MDPP, and after gaining experience during the
COVID-19 PHE, CMS made changes to the MDPP to
synch the program more with the National
Diabetes Prevention Program (National DPP).
And if organizations, that provide the MDPP,
structure their delivery process using the
low-cost, group-based, evidence-based,
DPP-coach-delivery model the National DPP is built
on, the organizations can receive reimbursement
that more than covers the cost of delivery
(typically $400.00 to $500.00 per participant).
In the new rules, CMS added a DPP
asynchronous virtual delivery option. And the pay
structure is fee-based and value-based. The number
of G-codes has been reduced from 15 to 6. There is
one G-code for in-person attendance, and one
G-code for virtual attendance.
The new reimbursement amount for an in-person or
virtual attendance will is $25. There is a G-code
for a 5% weight loss, with a reimbursement payment
of $145. When an MDPP participant attends all 22
sessions, the MDPP provider will receive a payment
of $550.00. When an MDPP participant attends all
22 sessions and reaches all weight loss
milestones, the provider will receive $768.00.
There were changes to the proposals, but because
of criticism, lessons learned during the PHE, and
the desire to prevent or delay type 2 diabetes for
Medicare beneficiaries, CMS made the above changes
to the MDPP.
The American Medical Association has been
endorsing and promoting the National DPP for some
time. And if you are interested in determining
what might be your cost to deliver the National
DPP or the MDPP, you can use the Budget
Tool that the AMA offers.
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