Pre-diabetes program available to Medicare patients beginning April 1

It’s no April Fool’s joke. Medicare is expanding its diabetes prevention program effective with dates of service on or after April 1.  

The Medicare Diabetes Prevention Program (MDPP) is a structured behavioral change intervention designed to work with Medicare beneficiaries diagnosed as being pre-diabetes to help prevent their condition from developing to type 2 diabetes. It began as a pilot project but is now being offered to all eligible beneficiaries, who will be able to access MDPP services in community and health care settings furnished by coaches that are trained community health workers or health professionals.

Family physicians can provide these services. Even if they don’t, however, they will likely want to inform patients who are diagnosed with pre-diabetes and who meet the criteria below about the MDPP and help them find those resources locally.

The MDPP services will be available to beneficiaries who:

• Are enrolled in Medicare Part B;
• Have a body mass index (BMI) of at least 25 if not self-identified as Asian or a BMI of at least 23 if self-identified as Asian;
• Have a hemoglobin A1c test with a value between 5.7 percent and 6.4 percent, a fasting plasma glucose of 110-125 mg/dL, or a two-hour plasma glucose of 140-199 mg/dL (oral glucose tolerance test);
• Have no previous diagnosis of type 1 or type 2 diabetes except for gestational diabetes; and
• Do not have end-stage renal disease.

MDPP participants will attend at least 16 hour-long “core” sessions during the first six months. This will be followed by monthly core sessions over the next six months, which they can attend regardless of weight loss. If the beneficiary maintains a weight loss of at least 5 percent for three months, he or she will have access to three-month intervals of ongoing maintenance after that. Medicare cost-sharing will not apply to MDPP services.

Additional information, including how to provide the MDPP services, is available on the CMS web site.

– Barbie Hays, Coding and Compliance Strategist, and Kent Moore, Senior Strategist for Physician Payment, at the American Academy of Family Physicians