Medicare Diabetes Prevention Program (MDPP) Model Expansion: New Guidance

New Guidance Released: Medicare Diabetes Prevention Program (MDPP) Beneficiary Eligibility Verification

Medicare beneficiaries must meet six eligibility criteria to have coverage of MDPP services. One of these criteria is that the individual have Medicare Part B coverage through Original Medicare (Fee-for-Service) or a Medicare Advantage (MA) plan.

The Centers for Medicare and Medicaid Services (CMS) has released guidance for MDPP suppliers on how to verify a beneficiary’s Medicare coverage to determine whether or not the beneficiary is eligible for coverage of MDPP services.

A full list of MDPP beneficiary eligibility requirements, including those criteria that can be self-reported, can be found in the MDPP Beneficiary Eligibility Fact Sheet.

New Guidance Released: Updates to the MDPP Payment Rates for Calendar Year 2019 (CY 2019)

The CY 2018 MDPP payment rates were established in the CY 2018 Medicare Physician Fee Schedule final rule. This rule also established that MDPP payment rates will be adjusted each calendar year using the Consumer Price Index. The updated payment rates for CY 2019 can be found here.