Friday, March 29, 2024

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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