March 29, 2021 Network in the Know

National Diabetes Prevention Program

The National Diabetes Prevention Program (NDPP) was established to prevent or delay the onset of type 2 diabetes. Taught by trained lifestyle coaches, the program helps educate and motivate people at risk for type 2 diabetes to adopt a healthier lifestyle. CDPHP offers coverage to eligible Medicaid and HARP members to participate in 22 sessions of the NDPP program over the course of one year.

Eligibility

To be eligible for the NDPP program, Medicaid and HARP members must:

  • Be at least 18 years old and overweight (body mass index ≥25, or ≥23 if Asian American).
  • Not be pregnant.
  • Not have been previously diagnosed as having type 1 or type 2 diabetes (except for gestational diabetes).

Additionally, they must meet one of the following criteria:

  • A blood test in the prediabetic range within the past year.
  • A previous diagnosis of gestational diabetes.
  • A score of 5 or above on the CDC/ADA Prediabetes Risk Test

Coding

If your patient meets the eligibility criteria and could benefit from the NDPP program, the following procedure codes would apply:

  • G0403T – A $22.00 per-member, per-session reimbursement for members who attend in-person NDPP group counseling sessions.
  • G9880 – A one-time NDPP incentive payment of $70.00 that is awarded to members when they first achieve at least a 5 percent weight loss from their baseline. 
Adele O'Connell
About the Author

Adele joined CDPHP in 2004 as an internal communications and event specialist. She then spent eight years coordinating the company’s community relations and corporate events program, in which capacity she worked with a host of non-profit organizations and co-chaired the CDPHP annual Charity of Choice campaign. Currently, she is a communications specialist and coordinator of corporate member engagement and serves on the boards of two local charities. Prior to CDPHP, Adele served as a legislative assistant for a trade association and as an acquisitions and developmental editor, specializing in educational and medical publishing. She earned a bachelor’s degree in English from Rosemont College.

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