This article was revised on July 30, 2020, to update the effective timeline.
Independence is committed to providing our members with access to the care they need during the COVID-19 pandemic. We encourage all Independence members and providers to visit our dedicated COVID-19 webpage regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.
Temporary changes to Medicare Diabetes Prevention Program
Effective March 6, 2020, and for the duration of the public health emergency, the Centers for Medicare & Medicaid Services (CMS) has waived requirements on multiple services to allow the continuation of medical treatment and minimize potential exposure.
CMS made temporary changes to the Medicare Diabetes Prevention Program (MDPP) for the duration of the public health emergency:
- Increase the number of virtual make-up sessions that can be offered by MDPP suppliers.
- Allow MDPP suppliers to deliver certain sessions virtually.
- Waive the once per life time benefit and allow MDPP beneficiaries whose sessions were suspended to resume sessions or start over.
The MDPP is covered as a preventive service over a two-year period for individuals enrolled in a program approved by the Centers for Disease Control and Prevention (CDC) for all sessions when all the following criteria are met:
- Body Mass Index (BMI) of at least 25 (23 if self-identified as Asian) on the date of the first core session
- Any of the following blood test requirements have been met:
- A hemoglobin A1c test with a value between 5.7% and 6.4%
- A fasting plasma glucose of 110-125 mg/dL
- A 2-hour plasma glucose of 140-199 mg/dL (oral glucose tolerance test)
- No documented history of diabetes prior to the date of the first core session (except for gestational diabetes)
- No diagnosis of end-stage renal disease (ESRD)
- Has not previously received diabetes prevention program services
MDPP sessions are covered as a preventive service over a two-year period. For the duration of the COVID-19 outbreak, this benefit is covered more than once during a member’s lifetime. Sessions will be covered when performed through a face-to-face or virtual encounter.
Core Sessions. Provided in the first 6 months of starting the program. A minimum of 16 core sessions provided at least a week apart are covered as a preventive service.
Core Maintenance Sessions. Provided in the following 6 months after the core sessions. A minimum of 6 monthly sessions are covered as a preventive service.
Ongoing Maintenance Sessions. Provided in the following 12 months after the core maintenance sessions. Monthly ongoing maintenance sessions are covered as a preventive service when the individual has documentation of a 5 percent weight loss during month 10 through month 12 of the core maintenance sessions.
If you have a patient who could benefit from MDPP sessions, please read this
article to learn how to find a supplier.
Medical policy and coding
Review Medicare Advantage policy #MA00.003m: Preventive Care Services for more information about MDPP.
A list of codes for MDPP can be found in the policy or in the
Medicare Diabetes Prevention Program in Response to COVID-19 Outbreak, found on the Medical Policy Portal.
For more information about Independence’s position on COVID-19, please review the following resources: