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Medicaid MCOs → Coding & Billing

 

Coding & Billing

 

The sustainability of the National Diabetes Prevention Program (National DPP) lifestyle change program in a Medicaid managed care system will depend on providers’ (CDC-recognized organizations) ability to bill and/or code for their services. The purpose of these sections is to provide a framework to ensure the National DPP lifestyle change program is reimbursed appropriately and in a timely manner.

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This section provides information on the diagnoses (ICD) and procedure (CPT) codes that can be used by CDC-recognized organizations. This section will continue to evolve as new codes are developed and processes change over time.

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This section outlines two primary billing models Medicaid managed care organizations (MCOs) can use when covering the National DPP lifestyle change program: (1) CDC-recognized organizations can invoice for payment based on the terms defined in the contract. (2) CDC-recognized organizations can submit a claim.