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.
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.
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.