Receiving CDC Recognition and Medicare Enrollment

Organizations who wish to furnish MDPP services to beneficiaries and bill Medicare for those services must enroll in Medicare as an MDPP supplier.

To become a Medicare-enrolled MDPP supplier, organizations must first meet specific CDC requirements to gain preliminary or full recognition status with the DPRP, and then must meet CMS requirements for enrollment as an MDPP supplier.

To enroll as an MDPP supplier, follow these steps:

1. Gain CDC National Diabetes Prevention Program recognition. Organizations must obtain preliminary or full recognition from the CDC by:
   • offering the lifestyle program within six months of receiving approval from CDC and receiving “pending” recognition status,
   • delivering the program over at least one year, including at least 16 sessions during the first six months and at least six sessions during the last six months,
   • complying with standards for recognition in the CDC Diabetes Prevention Recognition Program Standards and Operating Procedures and
   • submitting data on participants’ progress, including attendance, weight loss and physical activity every six months.
2. Prepare for the Medicare enrollment process by reviewing the MDPP Enrollment Preparation Guide and:
   • obtain a NPI and TIN, if the organization doesn’t already have one,
   • create an I&A account,
   • gather documentation showing MDPP preliminary or full CDC DPRP recognition,
   • identify at least one appropriate administrative location and community settings if applicable,
   • collect information on organizations and individuals with five percent or more,
   • ownership of, partnership in, or managing control of the organization (if applicable),
   • gather information on coaches who will furnish MDPP services and
   • gather information on authorized and delegated officials of your organization.
3. Enroll in Medicare as an MDPP supplier by applying via the Provider Enrollment, Chain, and Ownership System (PECOS) or the CMS-20134 paper application.

Organizations wishing to furnish MDPP services must enroll as an MDPP supplier, regardless of any existing enrollment in Medicare. For more detailed instructions, refer to the MDPP Preparing to Enroll as an MDPP Supplier Fact Sheet.

Organizations must also meet MDPP supplier standards to successfully enroll and maintain enrollment in Medicare. For more information, refer to the MDPP Supplier Requirements Checklist.

Note: There’s no provider enrollment application fee for all organizations enrolling in Medicare as MDPP suppliers. 

Individual coaches obtain National Provider Identifiers (NPIs) through the National Plan and Provider Enumeration System (NPPES).

Providers are responsible for maintaining coaches within their organization by updating the PECOS enrollment records. On the MDPP enrollment application, submit a list of MDPP coaches who will lead sessions, including full name, date of birth, SSN and active and valid NPI.

Related Content

• MLN® Booklet: Medicare Diabetes Prevention Program Expanded Model

Revised 12/14/2023