Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) Changes to the Medicare Diabetes Prevention Program (MDPP)

The Centers for Medicare & Medicaid Services (CMS) Medicare Diabetes Prevention Program (MDPP) is an evidence-based behavioral intervention that aims to prevent or delay the onset of type 2 diabetes for eligible Medicare beneficiaries diagnosed with prediabetes. MDPP is a non-pharmacological behavioral intervention consisting of up to 22 intensive sessions furnished over 12 months by a trained Coach. MDPP, through its focus on long-term dietary change, increased physical activity, and behavior change strategies for weight control, contributes to the CMS Innovation Center Strategy to Make America Healthy Again by promoting evidence-based prevention, reducing the incidence or slowing the progression of chronic disease among Medicare beneficiaries, and empowering beneficiaries to achieve their health goals.[1]

MDPP sessions adhere to a Centers for Disease Control and Prevention (CDC) approved National Diabetes Prevention Program (National DPP) curriculum.[2] CDC administers a national quality assurance program recognizing eligible organizations that furnish the National DPP through its evidence-based Diabetes Prevention Recognition Program (DPRP) Standards, which are updated every 3 years.[3]

Through the Calendar Year (CY) 2026 Physician Fee Schedule (PFS) Final Rule, we are finalizing several changes which are aimed toward increasing uptake of and access to this important prevention-focused program, empowering beneficiaries, and promoting further alignment between MDPP and the CDC DPRP Standards. The finalized changes include:

Updated weight collection requirements

• In section § 410.79 (c)(1)(ii), we finalized a change to allow for the submission of weight collected as part of a medical record, dated within five (5) days of a scheduled MDPP session, to reduce burden, promote safety, and increase access.
• In section § 410.79 (e)(3)(iii)(C), we updated weight collection requirements to allow beneficiaries to self-report weight for MDPP sessions from home or a reasonable location outside of an In-person delivery site. Examples of a reasonable location outside of an In-person delivery site include, but are not limited to, fitness centers, medical facilities, and temporary abodes (e.g., travel accommodations or a family member’s home).

Extended the flexibilities allowed during the PHE for COVID-19 through December 31, 2029

• In section § 410.79(b), we further extended flexibilities allowed during the Public Health Emergency (PHE) for COVID-19 through December 31, 2029. This includes the option for MDPP suppliers to deliver some or all MDPP sessions via Distance learning and for beneficiaries to self-report weight for MDPP Distance learning sessions.

Added coverage for asynchronous, Online delivery of MDPP through December 31, 2029

• We finalized a change to test the inclusion of an asynchronous delivery modality by adding § 410.79 (f). This modification is aimed toward increasing program participation among suppliers and beneficiaries and promoting alignment between MDPP and the CDC DPRP Standards. The inclusion of the Online, asynchronous delivery modality is considered a test during the Online delivery period, defined in section § 410.79 (b), to determine if evaluation results, including weight loss, are similar to In-person and Distance learning delivery modalities.

• We added paragraph § 414.84 (c)(3) to indicate payment for Online delivery ($18) with the inclusion of a new HCPCS G-code for Online delivery. For each beneficiary, MDPP suppliers must either bill claims with G9886 (In-person, group counseling, 60 minutes), G9887 (Distance learning, group counseling, 60 minutes), a combination of G9886 and G9887, or the new G-code for Online delivery. Performance payments for 5 percent weight loss achieved from baseline weight (G9880) and 9 percent weight loss achieved from baseline weight (G9881) will remain the same regardless of delivery modality for MDPP.

  Note: In order to evaluate the efficacy of Online delivery during the Online delivery period, beneficiary outcomes from synchronous (e.g., In-person, Distance learning, or In-person with a distance learning component) delivery of the Set of MDPP services must be compared to beneficiary outcomes from asynchronous (e.g., Online), therefore, synchronous and asynchronous modalities may not be combined and must remain mutually exclusive for individual beneficiaries.

Clarified that MDPP suppliers are not required to maintain In-person delivery capability through December 31, 2029

• In section § 410.79 (f)(2), we clarified that MDPP suppliers are not required to maintain In-person delivery capability through December 31, 2029, to facilitate the ability of MDPP suppliers to deliver the program asynchronously. This will allow for virtual-only organizations to enroll in Medicare as an MDPP supplier and streamline the process to allow for greater asynchronous delivery.