Medicare Diabetes Prevention Program Expanded Model Brings Opportunities for MDPP Suppliers, Coaches, and Individual Beneficiaries
Recent changes to the Medicare Diabetes Prevention Program (“MDPP”) are in sync with recent Centers for Medicare and Medicaid Services (“CMS”) initiatives to utilize technology to make healthcare services more accessible and that focus on preventative services.[1]
What is the MDPP?
The MDPP is an evidence-based behavioral change / structured lifestyle intervention that aims to prevent or delay the onset of Type 2 diabetes for eligible Medicare beneficiaries diagnosed with prediabetes, through a combination of diet, physical activity and weight loss.[2] Another purpose of the program is to reduce Medicare costs associated with the treatment and effects of diabetes.[3]
A Medicare provider must achieve recognition for its diabetes prevention program from the Centers for Disease Control and Prevention (“CDC”) before the provider is eligible to enroll as a MDPP supplier through their respective Medicare Administrative Contractor (“MAC”).[4] This recognition typically can take two years, but there are opportunities to fast-track the process.[5]
To participate in the program, Medicare beneficiaries must have:
- Medicare Part B coverage through fee-for-service Medicare or a Medicare Advantage Plan;
- Results indicating prediabetes from one of three blood tests; and
- A body mass index of at least 25 (23 if a self-identified Asian).
In addition, the beneficiaries must not have either a history of Type 1 or Type 2 diabetes (there is an exception for gestational diabetes) or end-stage renal disease.[6]
A MDPP participant may attend up to 22 behavioral counseling sessions within a 12-month period - 16 core sessions in the first six months and then up to six monthly follow-up sessions.[7] The counseling sessions are conducted by trained coaches who obtain a valid National Provider Identifier (“NPI”) and can be employees, contractors, or volunteers at the MDPP.[8]
MDPP suppliers are reimbursed for these sessions and can receive additional reimbursement if the MDPP participant meets milestones for weight loss of 5% and 9% from their baseline weight.[9] A key component for MDPP supplier reimbursement is documented weight loss. MDPP suppliers have multiple options for obtaining weight measurements for baseline weight and for meeting milestone weight-loss achievements.[10]
What Changed in the MDPP Program
The Consolidated Appropriations Act, 2026, signed into law on February 3, 2026, created an expanded MDPP model beginning on January 1, 2026, through December 31, 2029.[11] Some of the key changes include:
- Online Coaching Sessions are Allowed. “Online session” means an MDPP session that isn’t provided in person or through distance learning and is provided in a manner consistent with the CDC standards for online sessions. CMS will collect data to evaluate if online sessions are as effective as in-person and distance learning sessions.[12]
- Virtual-Only Organizations can be MDPP suppliers. Organizations that provide MDPP services solely through distance learning (live) or online (non-live) are allowed as long as the organization meets all other MDPP enrolment requirements.[13]
- Removal of Once-Per-Lifetime Limit for MDPP Beneficiary Participation. There is no longer the restriction that a MDPP beneficiary can only participate in the MDPP once in their lifetime.[14]
- Weight Loss Documentation from Medical Records. Weight documented in the participant’s medical record and dated within 5 days of the coaching session can now be used.[15]
- Weight Loss Allowed to be Reported from Other Reasonable Locations. There are now six accepted ways for MDPP participants to self-report their weight to the MDPP: (1) in-person measurement by the MDPP supplier; (2) digital scale that transmits the weight via wireless technology to the MDPP supplier; (3) live video weigh-in; (4) date-stamped photograph(s); (5) video recording; and (6) medical records. Previously, video weigh-ins and photographs had to be taken at home, but under the expanded model they can be taken at other reasonable locations like fitness centers or medical facilities.[16]
How do Current and Prospective Suppliers Learn More
On April 23, 2026, CMS will host an online summit that will educate prospective and current suppliers about the MDPP, and the recent changes brought with the expanded model. The link to register can be found here.
If you need assistance with MDPP enrollment or other reimbursement issues, please reach out to Maynard Nexsen.
[1] https://www.cms.gov/newsroom/press-releases/hhcms-announce-healthcare-advisory-committee-members-improve-patient-care-modernize-u-s-healthcare
[2] 42 CFR § 410.79.
[3] CMS MDPP Expanded Model Fact Sheet at https://www.cms.gov/priorities/innovation/files/mdpp-expansion-fact-sheet.pdf
[4] CMS MDPP Partnership Roadmap at https://www.cms.gov/priorities/innovation/files/mdpp-partner-roadmap.pdf
[5] https://nationaldppcsc.cdc.gov/s/article/Opportunities-to-Fast-Track-to-Preliminary-Recognition-Status
[6] https://www.cms.gov/priorities/innovation/files/mdpp-newsletter-mar2026.pdf
[7] https://www.medicare.gov/coverage/medicare-diabetes-prevention-program#:~:text=Facility-Description,with%20similar%20goals%20and%20challenges
[8] https://www.cms.gov/priorities/innovation/files/fact-sheet/mdpp-coachelig-fs.pdf
[9] 42 CFR § 410.79.
[10] https://www.cms.gov/priorities/innovation/files/mdpp-newsletter-mar2026.pdf
[11] https://www.congress.gov/bill/119th-congress/house-bill/7148/text
[12] MLN Booklet at https://www.cms.gov/files/document/mln34893002-medicare-diabetes-prevention-program-expanded-model.pdf
[13] See id.
[14] See id.
[15] See id.
[16] See id.
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