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MDPP (Medicare Diabetes Prevention Program) Q&A

What is Medicare Diabetes Prevention Program?

The MDPP (Medicare Diabetes Prevention Program) is a Medicare Part B program that teaches the person already diagnosed with prediabetes to make behavioral changes in his/her life. The goal is to prevent type 2 diabetes in those who are more at risk.

What is prediabetes?

Prediabetes can be defined as having a blood sugar (blood glucose level) that is above normal but does not meet the standards to be diagnosed for diabetes. If not treated, your body may eventually develop diabetes. Prediabetes can be reversed with proper treatment and behavioral changes. There are several risk factors (modifiable and nonmodifiable) that can put you at risk for prediabetes.

What is a modifiable risk? What is a nonmodifiable risk?

Modifiable risk factors are those risk factors that we can control. For prediabetes, the modifiable risk factors are:

Not being physically active at least three times a week
Poor diet (high in sugars and fatty foods)
Being a smoker
Being overweight
Your medical history (if left untreated) such as history of high blood pressure, history of gestational diabetes, being diagnosed with polycystic ovary syndrome, or having sleep apnea

Nonmodifiable risk factors are those risk factors we can’t control. For prediabetes, the nonmodifiable risk factors are:

Age 45 or older
Being male
Certain races/ethnicities- African Americans, Hispanic/Latino Americans. American Indians, Pacific Islanders, and Asian Americans are more at risk
Having a parent or sibling with type 2 diabetes

The CDC, in partnership with American Diabetes Association developed a Prediabetes Risk Test to help you determine your risk of developing prediabetes. The tool uses both modifiable as well as nonmodifiable risk factors to help you determine your risk.

How is prediabetes diagnosed?

Your health care provider can determine if you have prediabetes by performing one of three simple blood tests.

Hemoglobin A1c (HgA1c) test determines what your average blood glucose has been over the past 2-3 months. It is the main test that health care providers use to diagnose prediabetes. You do not need to fast before taking this test. Your blood will be drawn and tested for the HgA1c level. Hemoglobin A1c level of 5.7-6.4% indicates prediabetes.
Fasting blood glucose requires you to fast at least 8 hours prior to the test. Your blood will be drawn then tested for the blood glucose level. Fasting blood glucose level of 110-125 mg/dL indicates prediabetes.
The glucose tolerance test measures how your body responds to glucose. You will need to fast overnight prior to taking this test. A fasting blood glucose is first obtained as a baseline. Next, you will drink a glucose solution. The glucose solution needs to be finished within five minutes. Two hours after you have finished the glucose solution, you will have your blood drawn again. The results will then be analyzed. Two-hour blood glucose level of 140-199 mg/dL indicates prediabetes.

How do I qualify for the MDPP?

To qualify for Medicare Diabetes Prevention Program (MDPP), you will need to meet the following eligibility criteria:

Enrolled in Medicare Part B through Original Medicare (Fee-for-Service) or Medicare Part C (Medicare Advantage plan)
Have one of the following results within 12 months prior to the 1st core session
- Hemoglobin A1c level of 5.7-6.4%
- Fasting blood glucose level of 110-125 mg/dL
- Two-hour blood glucose level of 140-199 mg/dL
Body Mass Index (BMI) of at least 25 (or at least 23 if self-identified as Asian)
- Your height and weight will be measured in person at your first core session to calculate your BMI.
No history of type 1 or 2 diabetes (gestational diabetes not included)
No diagnosis of End Stage Renal Disease (ESRD)
Have not previously received Medicare Diabetes Prevention Program (MDPP) services

You will need to meet all the eligibility criteria to qualify for this program.

What is the cost to participate in MDPP?

There is no copay to participate. You do not need a physician’s referral to enroll. Medicare will cover up to 12 months of MDPP services, if eligible.

Please note- You are only eligible for MDPP once per lifetime.

What are the details of the MDPP?

The Medicare Diabetes Prevention program uses CDC-approved curriculum focused on diet, physical activity, and weight loss. This curriculum will assist you with making positive behavioral changes in your life to help prevent the development of type 2 diabetes. MDPP consists of up to 12 months of MDPP services.

The program is comprised of at least 16 weekly core sessions spaced at least one week apart during the months 1-6 of the MDPP service period.
The program is comprised of two 3-month core maintenance sessions during the months 7-12 of the MDPP service period.

Please note : For beneficiaries that started MDPP services on or before December 31, 2021, the following conditions apply: MDPP consists of up to 24 months of MDPP services if you meet the weight loss and attendance goals during the program.
For the first 12 months of MDPP:

The program is comprised of 16 weekly core sessions spaced at least one week apart during the months 1-6 of the MDPP service period.
The program is comprised of two 3-month core maintenance sessions during the months 7-12 of the MDPP service period.
You are eligible to attend MDPP sessions for the first 12 months regardless of your attendance or weight loss.

If you meet the weight loss and attendance goals, you will then be eligible for an additional 12 months of maintenance sessions. The following is a list of the goals required to attend the first three months of maintenance sessions in year two (months 13-15):

Attend at least one core maintenance session in-person during months 10-12
Meet or maintain 5% weight loss goal
Please note that all weight loss measurements need to be taken at an in-person session.

The second 12 months of MDPP:

The program is comprised of four 3-month ongoing maintenance sessions during the months 13-24 of the MDPP service period.
The sessions are broken up into intervals every three months
- Interval 1 (months 13-15)
- Interval 2 (months 16-18)
- Interval 3 (months 19-21)
- Interval 4 (months 22-24)
You are eligible to continue to attend MDPP sessions for the second 12 months if you meet the attendance and weight loss goals.
- Goals are measured for attainment before each interval to determine if you meet eligibility to continue in MDPP.
The following is a list of the goals required to continue to attend MDPP maintenance sessions
- Attend at least two maintenance sessions with at least one session being in-person
- Maintain 5% weight loss goal
Please note that all weight loss measurements need to be taken at an in-person session.

How long are the sessions?

Each session is approximately one hour in length.

Am I still eligible to participate if I develop diabetes while in the MDPP?

If you develop diabetes while receiving MDPP services, you may continue to attend sessions and participate with the program.

What happens if I miss a session?

You can make up missed sessions if your education center provides these sessions. There is no requirement for the education center to provide makeup sessions so please check with the education center that you attend for more information. The education center may only provide one makeup session a week.

What are the benefits for me in enrolling in this program?

You will receive support and education from trained professionals to assist you with developing strategies for healthy behavioral changes.
- You will develop lifelong healthy habits that you can use after the sessions are complete.
There will be less of likelihood that you will develop type 2 diabetes.
- People diagnosed with diabetes are more likely to develop heart disease, stroke, vision loss related to damage to the blood vessels of the eyes, kidney damage and end stage renal disease, nerve damage and numbness, and diabetic wounds /ulcers.

How can I enroll?

Talk to your health care provider about this program. Your health care provider will be able to determine if you meet the eligibility criteria to enroll. If you qualify to enroll, your health care provider can provide you the necessary information about the MDPP program so you can get started.

Resources

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

AMA Disclaimer of Warranties and Liabilities.

CMS Disclaimer

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

MDPP (Medicare Diabetes Prevention Program) Q&A

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