2025 Medicare Diabetes Prevention Program (MDPP) Expanded Model Updates

To support our providers in delivering high-quality care to our Medicare members, here are the key changes you need to know. These changes affect members in our Medicare Signature HMO, Medicare Signature PPO, and CompleteCare (HMO D-SNP) plans.

What is the Medicare Diabetes Prevention Program?

MDPP is a structured, evidence-based lifestyle change program designed to help Medicare beneficiaries diagnosed with prediabetes reduce their risk of developing type 2 diabetes. Through coaching and support focused on nutrition, exercise, and behavioral changes, the program aims to help participants achieve sustained weight loss of at least 5%—a proven strategy to lower diabetes risk.

What are the key changes to the Medicare Diabetes Prevention Program?

The MDPP expanded model enhances the original program by broadening access and offering greater flexibility in how services are delivered.

Expanded Delivery Modalities

MDPP sessions may now be delivered:

• In person
• Through distance learning (virtual)
• Through a hybrid approach (in person with a distance learning component)

Note: Hybrid programs must be recognized by the Centers for Disease Control and Prevention (CDC) and adhere to Diabetes Prevention Recognition Program (DPRP) standards.

Flexibility Extended Through December 31, 2027

CMS is allowing continued use of virtual delivery methods under COVID-19 flexibilities. MDPP suppliers may offer make-up sessions either in person or via distance learning.

Self-Reported Weight Guidelines for Virtual Sessions

Participants in distance learning sessions may self-report weight using one of the following methods:

• Live video demonstration with the participant and their scale
• Date-stamped photos of the participant and the scale reading
• Video recordings or connected digital scale transmissions (wireless or cellular)

Program Integrity and Billing Updates

• CPT G9890 (bridge payments) will be discontinued for dates of service on or after January 1, 2025. Suppliers may still bill G9890 if the beneficiary changed suppliers by December 31, 2024.
• Use Modifer 76 for same-day make up sessions when billing CPT codes G9886 or G9887 for same-day make-up sessions
• All MDPP services must meet CDC DPRP recognition standards for the applicable delivery format.

More Information

• Medicare Diabetes Prevention Program Expanded Model
• Medicare Learning Network: Medicare Diabetes Prevention Program Expanded Model Booklet

Questions?

If you have any questions, please contact your Network Account Manager, or call Provider Services at 1-888-801-1660, Monday to Friday, 8:30am-5:30pm.

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”).
Released July 2025