Billing Practices for Medicare Diabetes Prevention Program Services

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• Billing Practices for Medicare Diabetes
  Prevention Program Services

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Billing Practices for Medicare Diabetes
Prevention Program Services

• The Centers for Medicare and Medicaid Services
  (CMS) have expanded its Medicare Diabetes
  Prevention Program (MDPP) nationwide. Traditional
  healthcare providers and community-based
  organizations can enroll as Medicare suppliers of
  health behavior change services. MDPP model
  promotes patient centered care. This continues to
  test market driven reforms to drive quality of
  care.
• According to CMS Administrator Seema Verma, CMS
  recognizes that prevention is a critical part of
  creating an affordable healthcare system that
  puts patients first, and we encourage eligible
  suppliers to partner with us on this shared goal
  by participating in the national expansion of the
  MDPP.
• Medicare Diabetes Prevention Program
• Are you preparing to Enroll as an MDPP Supplier?
  CMS MDPP Billing and Claims Fact Sheet provide
  guidelines on proper MDPP billing practices and
  payment rules.
• Every claim must be submitted to suppliers
  Medicare Administrative Contractors (MACs)
  directly or to a billing agent. You need to take
  care of some important information while
  submitting claim such as
• Demo code 82 in block 19 of the CMS-1500 or its
  electronic equivalent\
• Appropriate G code(s) with the corresponding
  session date of service and rendering MDPP
  coachs National Provider Identifier (NPI)

Medical Billing Services in Oregon
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Billing Practices for Medicare Diabetes
Prevention Program Services

• Virtual modifier VM appended to any G code
  associated with a session that was furnished as a
  virtual makeup session as well as MDPP supplier
  organizational NPI
• Certain G-codes that can be used include
• G9874 MDPP beneficiary attended a total of 4 MDPP
  core sessions
• G9875 MDPP beneficiary attended a total of 9 MDPP
  core sessions
• G9876 MDPP beneficiary attended 2 MDPP core
  maintenance sessions in months 7-9
• G9877 MDPP beneficiary attended 2 MDPP core
  maintenance sessions in months 10-12
• G9878 MDPP beneficiary attended 2 MDPP core
  maintenance sessions in months 7-9, and achieved
  the 5 weight loss from his/her baseline weight
  (Use G9878 or G9876)
• G9879 MDPP beneficiary attended 2 MDPP core
  maintenance sessions in months 10-12, and
  achieved the 5 weight loss from his/her baseline
  weight (Use G9879 or G9877)
• Medisys a professional medical billing company
  helps physicians to meet complex billing
  requirement with better accuracy. You can get in
  touch with us at 302-261-9187 or email us at
  info_at_medisysdata.com

Medical Billing Services in Oregon