CMS MDPP Billing and Claims Fact Sheet - CMS Innovation 2026

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  1. Click ‘Get Form’ to open the CMS MDPP Billing and Claims Fact Sheet in the editor.
  2. Begin by entering the Beneficiary's Last Name, First Name, and Middle Name in the designated fields. Ensure accuracy as this information is crucial for identification.
  3. Fill in the Birth Date, Gender, and CIN (Medi-Cal Card #). Select the appropriate gender option and provide any additional details required.
  4. Complete the Current Street Address, City, State, and Zip Code fields. This information helps in determining service locations.
  5. In the Clinical Assessment section, document any safety risks and mental health history. Be thorough as this impacts treatment planning.
  6. For Part B – Partnership Plan for Wellness, outline specific treatment goals that are observable and quantifiable. This ensures clarity in treatment expectations.

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Covers certain doctors services, outpatient care, medical supplies, and preventive services. covers up to 2 blood glucose (blood sugar) laboratory test screenings (fasting or non-fasting) each year if your doctor determines youre at risk for developing diabetes.
MDPP Capacity Assessment Developed with input from experienced MDPP suppliers, this tool is designed to help CDC-recognized organizations assess their capacity and readiness to become an MDPP supplier or to implement the MDPP.
Participants enrolled in the Medicare Diabetes Prevention Program (MDPP) cannot self-report blood test results; lab results must be provided.
The Medicare Diabetes Prevention Program (MDPP) Expanded Model is a structured behavior change intervention intended to prevent type 2 diabetes in people with prediabetes who have Medicare.
The MDPP expanded model allows Medicare beneficiaries to access evidence-based diabetes prevention services with the goal of a lower rate of progression to type 2 diabetes, improved health, and reduced spending.

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