Medicare Diabetes Prevention Program (MDPP) questions and answers

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Home ► FAQs ► Medicare Diabetes Prevention Program (MDPP) questions and answers

Last Modified: 3/19/2025 Location: FL, PR, USVI Business: Part B

Medicare Diabetes Prevention Program (MDPP) questions and answers

The following document was developed based on questions regarding the MDPP benefit.

Comprehensive information on the MDPP benefit can be referenced on our Provider specialty page: Medicare diabetes prevention program (MDPP).

Enrollment

Q1. How do I enroll as an MDPP supplier?

A1. MDPP suppliers need to complete the CMS-20134 external pdf file

application.

Sources: Completing the Medicare Enrollment Application - Medicare Diabetes Prevention Program (MDPP) Suppliers (CMS-20134) Application;
MDPP Enrollment Tutorial the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) (cms.gov) external pdf file

Q2. What is your policy for deactivating MDPP suppliers, within a specific time period, that do not submit claims (i.e., what is the time period)?

A2. CMS is responsible for sending the deactivation lists to the MAC. They could request for a provider to be deactivated for not billing any claims for 6 months or longer.

Q3. How often are MDPP suppliers required to update their coach roster?

A3. MDPP suppliers must update changes to the coach roster in PECOS within 30 calendar days to avoid claims being rejected or denied.

Source: MDPP Coach Eligibility Fact Sheet external pdf file

Billing

Q1. What HCPCS codes should be used for MDPP reporting?

A1. CMS has developed Billing and Coding Cheat Sheets to assist with reporting. See the 2024 MDPP Billing and Claims Cheat Sheet external pdf file

for the list of current codes.

Source: 2024 MDPP Billing and Claims Cheat Sheet external pdf file

Q2. What is the average time for response to a submitted claim? Meaning, the turnaround time (e.g., 30, 45, or 60-day time window)?

A2. Electronic claims 14 days, paper would be 29. Best practice is to wait 30 days for claim finalization prior to resubmitting.

Q3. Where within the claim form should an MDPP supplier include the Demonstration Code "82"?

A3. MDPP suppliers should report Demonstration Code "82" in Item 19 on the CMS-1500 claim form or in the EDI equivalent 2300 REF01 P4 and 2300 REF02 82.

Beneficiary Eligibility

Q1. What if a beneficiary moves to a location where there is no MDPP supplier after he or she has started receiving the set of MDPP services?

A1. If there is no MDPP supplier in the new location, the beneficiary can attend virtual sessions through distance learning (e.g., a live virtual classroom), if offered. The beneficiary may also identify other MDPP suppliers that offer distance learning delivery of MDPP services.

Q2. Can an FFS Medicare patient enroll with any MDPP supplier offering distance learning MDPP sessions, even if the supplier is in a different state?

A2. Yes. Eligible FFS Medicare patients can enroll with any MDPP supplier offering MDPP sessions via distance learning, regardless of where the patient and supplier are located.

Q3. Can MDPP suppliers offer distance learning MDPP sessions to FFS patients living in other states?

A3. Yes.

Please note, suppliers must ensure all patients are eligible for MDPP under FFS Medicare and follow all Centers for Disease Control and Prevention (CDC) Diabetes Prevention Recognition Program (DPRP) standards for distance learning delivery. All MDPP suppliers must maintain the capacity to offer MDPP services in person, even if they are currently delivering most or all MDPP sessions via distance learning.

Q4. How should MDPP suppliers submit claims for MDPP sessions delivered via distance learning to patients located in other states?

A4. MDPP suppliers submit all claims for MDPP services to their MAC, regardless of where the patient is located.

The claims submission process will be the same for MDPP sessions delivered via distance learning as for MDPP sessions delivered in-person.

MDPP suppliers will use “Other” (99) as their place of service (POS) code for sessions delivered via distance learning and HCPCS code G9887.

For MDPP billing, claims may list the currently enrolled practice location (not the coach’s home address) as the POS.

Sources: Medicare Diabetes Prevention Program (MDPP) - Frequently Asked Questions external link

;

Provider specialty: Medicare diabetes prevention program (MDPP)

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