Here’s the bad news: If you have patients older than 65 who don’t have diabetes, there’s probably a 50-50 chance they have prediabetes, according to the American Diabetes Association.
Now here’s the good news: A new Medicare program may pay you to help them avoid this disease.
The 2018 Medicare Physician Fee Schedule provides new coverage for diabetes prevention services through the Centers for Medicare & Medicaid Services’ (CMS’) Medicare Diabetes Prevention Program (MDPP). Enrollment is now open, although Medicare payment will begin for services provided on or after April 1.
The program covers classroom-style group instruction for Medicare patients by a “coach” trained to follow a Centers for Disease Control and Prevention (CDC)-approved curriculum on long-term dietary change, increased physical activity, and behavior change for weight control.
“To get paid under the MDPP, your practice has to enroll as a ‘supplier’ and provide the instruction,” said TMA practice consultant Juliana Stanley. “The coach most likely will not be the physician. A nurse practitioner, physician assistant, dietician, or registered nurse could the instructor.”
See the CDC website for coach training information.
The program’s “core benefit” consists of at least 16 weekly sessions over six months and at least six monthly maintenance sessions for six months after that. Additionally, Medicare will cover a series of four three-month maintenance sessions for up to one more year as long as patients meet attendance and weight-loss goals. CMS’ orientation webinar (registration required, or view the slides without audio) explains the program in depth.
You can earn a bonus of about $200 to $700, depending on the patient’s weight loss and, to a lesser extent, attendance. See the chart in this CMS fact sheet for details. CMS has published G-codes that MDPP suppliers will use to submit claims for payment.
To enroll for the program as an MDPP supplier, you must have preliminary recognition or full recognition under the CDC Diabetes Prevention Recognition Program (or until CDC establishes its preliminary recognition standards, you can qualify to enroll with CMS MDPP interim preliminary recognition). To enroll, complete the MDPP Supplier Enrollment Application either online though the Medicare Provider Enrollment, Chain, and Ownership System or through the paper form.
The Medicare Diabetes Prevention Program is a once-per-lifetime benefit for Medicare beneficiaries who meet certain criteria at the start of the program, including having no previous diagnosis of type 1 or type 2 diabetes. However, patients who develop diabetes during the MDPP services period remain eligible.
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