Payment for ASCs are made under a separate payment system. As such, certain modifiers are specific to ASCs. View the following article to learn more: Modifiers applicable to ASCs.

Learn which modifier to use when you expect Medicare will deny a claim that does not meet medical necessity criteria and whether you have or do not have an advanced beneficiary notice (ABN) signed by the beneficiary by viewing the following article: How to use modifiers to indicate the status of an ABN.

View the following list of codes that may not be corrected using the reopening process in SPOT. 

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.

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.
 

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.

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.