News: CMS announces changes to the Medicare Diabetes Prevention Program

CMS finalized changes to Medicare Diabetes Prevention Program (MDPP) in the 2026 Medicare Physician Fee Schedule (MPFS) final rule, including updating weight collection requirements, extending flexibilities allowed during the COVID-19 public health emergency (PHE), and updating the online delivery modality of the program, JustCoding reported.

The MDPP is a six-month program consisting of 16 sessions on topics aimed to help Medicare beneficiaries make behavioral changes to prevent type 2 diabetes. To be eligible for the program, beneficiaries must meet certain health conditions, such as a body mass index of 23 or greater. In group settings, participants receive training on diet and exercise from specially trained coaches to teach them and keep them motivated. Following the completion of the 16 sessions, participants receive six monthly follow-ups to help maintain the behavior changes around diet and exercise.

The 2026 MPFS final rule updates weight collection requirements, allowing beneficiaries to self-report their weight for MDPP sessions. Beneficiaries will also be able to submit their weight for an MDPP session if it was collected as part of a medical record within five days.

Prior to the COVID-19 PHE, MDPP sessions were predominantly delivered in person. The 2021 MPFS final rule included the option for some or all MDPP sessions to be delivered via distance learning and for beneficiaries to virtually self-report their weight. In subsequent years, beneficiaries had increasingly participated virtually or a mix of in-person and virtually as these flexibilities had been extended. The 2024 MPFS final rule extended the flexibilities though December 31, 2027. CMS has again extended the flexibilities to December 31, 2029.

CMS will also be testing the additional coverage of an asynchronous (i.e., not live) online delivery method of the MDPP through December 31, 2029. This testing period will aim to see if evaluation results, such as weight loss, are similar to other delivery modalities, such as in-person and distance learning. MDPP suppliers that deliver the program asynchronously are also not required to maintain in-person delivery capability through December 31, 2029, meaning virtual-only organizations will be able to enroll in Medicare as an MDPP supplier to allow for greater asynchronous delivery.

Editor’s note: This article originally appeared in JustCoding.