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Screen and Refer to the National DPP

If you’d like to offer the CDC-recognized lifestyle change programs you must submit an application and meet certain standards—such as having trained lifestyle coaches and using a CDC-approved curriculum. This ensures the programs are of high quality.

Screening Participants

Please contact your local health department lead or the Utah Department of Health for assistance.

Risk Assessment Criteria & Frequency

In October 2015, the U.S. Preventive Services Task Force (USPSTF) recommended screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese. Clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote a healthful diet and physical activity.

Age & BMI

Grade B recommentation

  • 40-70 age AND
  • BMI ≥ 25

The USPSTF standards suggest testing adults of a lower age or BMI if risk factors are present.

  • Family history
  • Medical history of gestational diabetes or polycystic ovary syndrome
  • Racial & ethnic minorities

Visit the AMA's Prevent Diabetes STAT website for more information.

Reference: Siu AL. U S Preventive Services Task Force. Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015;163(11):861-8.

Identifying Patients

For more information visit the CDC's website at www.cdc.gov/diabetes/prevention/lifestyle-program/deliverers/index.html.

Resources for screening, testing and referring on the CDC's website.

Referrals to National DPP

Research shows that patients are more likely to engage in preventive health behaviors when their health care professional recommends them.

Referring a Patient

A formal referral from the physician is a recommended best practice. The program administrator or coach typically reaches out to the patient and shares program details, which in turn increases the likelihood of enrollment. The Utah Deparment of Health will soon offer at no cost to physicians the use of an online bi-directional referral system to refer patients into the National DPP and other self-management classes.

Patients can be referred to the National DPP by downloading and printing our Fax Referral Form (PDF) and soon online!

Best Practices for Referrals

Listed here are a few best practices for enabling physicians and care teams to refer into National DPP classes:

Reimbursement for Prediabetes Screening

The following ICD billing code sheet will enable physician practices to obtain reimbursement for prediabetes screening.

ICD Billing Codes

Commonly Used Current Procedural terminology and ICD Codes (PDF)

Prevent Diabetes STAT Toolkit

The American Medical Association's (AMA) Prevent Diabetes STAT (Screen/Test/Act/Today) Toolkit is available for you to use to learn more on creating partnerships with healthcare organizations and clinics.

Business Associate Agreement

The AMA provides additional resources that may be helpful in connecting with diabetes prevention programs, including a sample Business Associate Agreement (PDF).

Sample Referral Form

Download and print the Sample Referral Form with a BMI table (PDF).

Be sure to watch the AMA’s Preventing Diabetes in At-Risk Patients (CME Credits: 1.0) at www.stepsforward.org/modules/prevent-type-2-diabetes

For more information visit the CDC's website at www.cdc.gov/diabetes/prevention/lifestyle-program/deliverers/index.html.

Medicare DPP (MDPP)

Beginning in January 2018, Medicare Part B insured participants will be able to attend the National DPP lifestyle change classes as a preventive benefit without a co-pay.

Requirements for Medicare DPP (MDPP)

In order to bill Medicare for reimbursement of the National DPP, the following must be met by your National DPP organization.

  1. Enroll as a Medicare provider and receive a National Provider Identifier (NPI) number.
  2. Have preliminary or full recognition status from the CDC’s DPRP program.
  3. Pay a one-time $500 enrollment fee to Medicare (CMS).

Details of the MDPP Benefit

  • Proposed MDPP Payment Model (PDF; Final in January 2018)
  • Core benefit is 12 consecutive months
  • Core sessions = at least 16 weekly core sessions over months 1-6
  • Core maintenance sessions = at least six monthly core maintenance sessions over months 6-12. Offered regardless of weight loss
  • CDC-approved core curriculum
  • Session duration requirement – approximately one hour
  • Ongoing maintenance sessions are offered monthly after the core benefit IF participants achieve and maintain the required minimum weight loss of five percent (5%)
    • “Maintenance of weight loss” – achieving the required minimum weight loss (5%) from baseline weight at any point during each 3 months of core maintenance or ongoing maintenance sessions
    • “Maintenance session bundle” – each 3-month interval of core maintenance or ongoing maintenance sessions

Beneficiary Criteria

  • Enrolled in Medicare Part B
  • BMI of at least 25 or at least 23 if self-identified as Asian
  • Have, within the 12 months prior to attending the first core session:
    • HgbA1c test with a value between 5.7 and 6.4 or
    • Fasting plasma glucose of 110 – 125 mg/dL or
    • 2-hour post-glucose challenge of 140-199 mg/dL
  • No previous diagnosis of type 1 or type 2 with the exception of gestational diabetes (GDM)
  • Do not have end-stage renal disease (ESRD)
  • No previous receipt of MDPP services

Beneficiaries who meet the eligibility criteria would only be able to receive MDPP services once in their lifetime.

MDPP Referral Options

  • Self-referral
  • Community-referral
  • Health care practitioner-referral (which includes non-physician practitioner referrals)

Who Can Be an MDPP Supplier?

  • An organization with preliminary or full recognition from the CDC’s Diabetes Prevention Recognition Program (DPRP). Prelimary recognition will require that an organization submit at least one year of class data to the CDC/DPRP.
  • Existing Medicare suppliers would have to enroll separately as MDPP suppliers and also pay a $500 enrollment fee to CMS.

What About Lifestyle Coaches?

  • Coaches need to obtain an CMS National Provider Identification (NPI).
  • National DPP organizations will need to submit a roster of coach NPIs, names and SSNs to CMS upon applying for enrollment as an MDPP supplier
  • Coaches cannot apply to be an MDPP supplier on their own
  • Just like the CDC DPRP’s definition of recognized programs, MDPP suppliers are at the organizational level
  • Any individual can become a Coach

What Can Your Organization Be Doing Now?

  • Understand enrollment regulations
  • Understand Screening regulations set forth in 424.518(c) for “High Categorical Risk”:
    • Site visit by CMS
    • Fingerprints required from anyone who has 5% or more ownership interest in the organization
    • Background checks
  • Understand the application process to enroll in Medicare - Internet Based PECOS
  • Download free software to submit claims – PC-ACE Pro32
  • Review process for obtaining a National Provider Identifier (NPI)
  • Continue to work toward obtaining full-recognition from the CDC’s DPRP
  • Work with provider groups to encourage Medicare beneficiary referrals with blood-based values
  • Watch for the new DPRP Standards and the next final rule (round 2) to come out in Spring/Summer 2017

Additional Resources