Diabetes Screening and Prevention

The Centers for Medicare & Medicaid Services (CMS) offers many resources to assist you when billing for diabetes screening and Diabetes Prevention Program (MDPP) services.

• CMS MLN Medicare Preventive Services Educational Tool — includes codes, who is covered, frequency, and what the beneficiary pays
• CMS IOM Pub. 100-04, Medicare Claims Processing Manual, Chapter 18 (PDF), Section 90 — Diabetes Screening
• CMS MLN Fact Sheet: Medicare Diabetes Self-Management Training (PDF)

Diabetes Prevention Program (MDPP) Expanded Model Resources

The Medicare Diabetes Prevention Program expanded model is a structured intervention with the goal of preventing type 2 diabetes in individuals with an indication of prediabetes. To learn more about MDPP please see the resources listed below:

• CMS MDPP web page
• MDPP supplier enrollment information:
  • Enrollment Fact Sheet (PDF)  
  • Enrollment Checklist (PDF)  
  • Enrollment application
• Medicare Diabetes Prevention Program (MDPP) billing and payment Fact Sheet (PDF)  
• Medicare Diabetes Prevention Program  Expanded Model Booklet
• Frequently Asked Questions (FAQ)    
• Medicare Diabetes Prevention & Diabetes Self-Management Training

Suppliers new to Medicare billing should go to the New to Medicare web section.  

Jurisdictions J and M Part B Education Opportunity for Medicare Diabetes Prevention Program Providers

Medicare Diabetes Prevention Program (MDPP) providers (enrolled specifically as an MDPP provider) have the opportunity to request a one-on-one educational session with the Palmetto GBA Outreach and Education Department.

The goal of the one-on-one educational session is to assist MDPP providers with claim submission questions and denial resolution. To request an MDPP education session, use the link below to complete and submit the education Request form. Once the request is received, Palmetto GBA will contact the MDPP provider to schedule a time for the educational call.

Jurisdiction J/M (PDF).