Medicare Diabetes Prevention Program (MDPP) changes for calendar year 2026

The once in a lifetime per patient restriction has been removed and there is no limit to the number of times a patient can enroll in MDPP services if they meet the requirements.

Online (non-live asynchronous) delivery mode is now available:

• HCPCS code G9871 has been added for online delivery (behavioral counseling for diabetes prevention, online, 60 minutes):
  • Modifier 76 should be used if online makeup session is completed on the same day as a regularly scheduled online session
• Sessions are delivered 100% through the internet via smartphone, tablet or laptop in asynchronous method during which a live coach is not teaching the content:
  • Live coach interaction must be offered to each participant during weeks when participant has engaged with content:
    • Emails and text messages count towards live interaction if there is bidirectional communication between coach and participant where both parties participate (chat bots and AI do not count towards live interaction)
    • Proactive outreach by the coach may be used to encourage session completion and reporting of weight
    • Bluetooth scales may be used for self-reporting of weight for online asynchronous program
• Organizations are no longer required to maintain in-person session capability during the online delivery period:
  • This will allow online-only organizations to enroll as MDPP suppliers and streamline the process for greater asynchronous delivery of MDPP services:
    • Online delivery period (January 1, 2026, to December 31, 2029) will be used to test the inclusion of the online delivery modality:
      • During this period beneficiary outcomes will be evaluated to determine if this modality reduces costs and improves quality
  • All sessions during the period must be delivered as synchronous, or asynchronous, and can't be intermingled
  • Organizations must ensure online participants engage with the content through use of one or more of the following:
    • Documented completion of videos/presentations
    • Knowledge checks
    • Participant contributions to group discussions on a community board
    • Interaction with a coach through email, text message, or in-app messaging

Flexibilities for distance learning were implemented during the PHE, and were originally in effect until December 31, 2027:

• These will now be in effect through December 31, 2029:
  • This would streamline the MDPP process by ensuring all delivery methods would be in effect through December 31, 2029

MDPP suppliers may use the weight documented in the patient's medical record and dated within five calendar days of the MDPP session or allow patients to self-report their weight for distance learning and online sessions until December 31, 2029, by doing one of the following:

• Using online video technology, like chatting or conferencing, so that the MDPP coach sees the patient taking their weight on a digital scale and views the weight shown on the scale
• Sending two date-stamped photos, one with their weight on a digital scale, and one of the patient visible in their home or another reasonable location outside of an in-person delivery site:
  • Examples of these sites include fitness centers, medical facilities, and temporary homes
• Alternatively, patients may send either:
  • A single date-stamped photo, if they're able to show both themselves and their weight on the digital scale
  • A video recording with them and their weight visible on the scale
• Using smart technology, as on some digital scales, to transmit their weight measurements securely through a wireless or cellular signal