- Learn About MDPP
- Framework for Prevention and Goals
- Delivering a Lifestyle Change for Medicare Beneficiaries
- Receiving CDC Recognition and Medicare Enrollment
- MDPP Codes and Payment Amounts 2023
- MDPP Codes and Payment Amounts 2024
- MDPP Billing Information
- Accessing Eligibility for MDPP in NGSConnex
- Contact Information and Resources
MDPP Billing Information
In addition to the usual information that needs to be completed to file a claim for a Medicare Part B service to your MAC, you will need to complete the following items of the CMS-1500 form or electronic equivalent with the required information below when filing for MDPP claims. Complete CMS-1500 claim form.
Note: Coaches affiliated with MDPP suppliers will furnish MDPP sessions to beneficiaries, but will not be enrolled in Medicare. Suppliers will list the coaches NPI as the rendering provider on the claim form submitted to the MAC.
| Line Item Number | Instructions |
|---|---|
| Item 19 | Enter Demo code 82 Loop 2300 segment REF01 (P4) and segment REF02 (82) |
| Item 21 | Enter the most appropriate ICD-10 diagnosis code for the beneficiary that captures the nature of the encounter or from a referral. Though referrals are not required, the MDPP supplier should use the most appropriate code (e.g., Z71.89 Other specified counseling). No specific diagnosis code is required for MDPP. Loop 2300 Segment HI02-1 to HI12-1 |
| Item 24A | Enter the date of service for each session Loop 2400 segment DTP03 (472) |
| Item 24B | Enter the 2-digit place of service code where the MDPP service was furnished (e.g., “Office” (11), Outpatient Facility Codes ( 19 or 22), or “Other” (99) if the place of service was furnished in a community setting or as a virtual make-up session) Loop 2300 segment CLM05-1 |
| Item 24D | For each session a beneficiary attends, the MDPP supplier will bill a G-code (refer to list). HCPCS codes associated with the MDPP service, including the non-payable codes when appropriate (e.g., report nonpayable codes for core sessions two and three on the same claim that you are billing for core session four attendance) Loop 2400 segment SV101-2 |
| Item 24J | Enter the MDPP Coaches’ NPI in the “Rendering Provider Identifier” section of 24J of the CMS 1500 form or its’ electronic equivalent for each session. Loop 2310B segment NM109 |
| Item 33 | Enter the supplier/organization billing provider name, address, city, state, ZIP and telephone Loop 2010AA or 2010AB segments NM103-NM105, N301, N401–N403, PER04 |
| Item 33A | Enter the supplier/organization NPI billing provider (specialty D1) Loop 2010AA segment NM109 |
Reviewed 9/27/2023