Programs & Initiatives in Communities – Improving Clinical Prediabetes Care: Clinician Tools and Resources

Programs & Initiatives in Health Care
Improving Clinical Prediabetes Care
Clinician Tools and Resources

A number of your patients may be at risk for type 2 diabetes, maybe more than you think. Here you’ll find resources to help your clinical team screen, counsel and refer your at-risk patients to proven prevention programs to support lifestyle change.

Prediabetes in Minnesota

Prediabetes is on the rise. A prediabetes diagnosis means a higher risk of developing type 2 diabetes, heart disease and stroke. However, most Minnesotans don’t even know they have prediabetes. Clinicians play a key role in identifying patients at risk, and intervening to prevent or delay the onset of diabetes and other related health risks.

Preventing type 2 diabetes

The American Medical Association (AMA) and the Centers for Disease Control (CDC) urge clinical health teams to screen and test patients: You Can Prevent Type 2 Diabetes (PDF). However, the road to reducing your patients’ risk for prediabetes doesn’t end at screening. Clinicians are encouraged to refer at-risk patients to the Diabetes Prevention Program (DPP) – a CDC-approved lifestyle change program that can help people with prediabetes cut their risk of developing type 2 diabetes in half.

The DPP curriculum is based on a research study that showed that people with prediabetes who lost a modest amount of weight – 5 to 7 percent, or about 15 to 20 pounds– reduced their risk of developing type 2 diabetes by 58 percent over a three-year period.

The National Diabetes Prevention Program site provides more in-depth information on the program.

For more detail on the DPP study and the ongoing DPP Outcomes Study, visit the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)'s Diabetes Prevention Program overview.

Many health care, community and worksite settings in Minnesota offer the DPP. Find a Diabetes Program to recommend to your patients who have prediabetes or are at high risk for type 2 diabetes.

Turning the Tide: Easy Tools for Clinicians to Prevent Type 2 Diabetes presents the latest research on prediabetes and information on how to receive reimbursement for prediabetes screening and counseling. The Twin Cities Medical Society, Minnesota Department of Health, Minneapolis Health Department and the Minnesota Medical Association developed this webinar. Complete the webinar and receive Continuing Medical Education credits.

Improving prediabetes care

The Prevent Diabetes STAT website and toolkit can help clinical teams incorporate workflows to screen, counsel and refer patients to proven diabetes prevention programs.

The M.A.P. to Diabetes Prevention (PDF) is a good place to start. This is a three-step Measure, Act, Partner guide to improve screening, counseling and referral.

Tools to improve at-risk patient identification and screening:

  • Point-of-care and retrospective prediabetes identification algorithms
  • Sample workflows and patient referral forms/tables for calculating body mass index
  • Commonly used Current Procedural Terminology and ICD codes to obtain reimbursement for prediabetes screening

Tools to engage your health care team:

  • Fact sheets to help advocate for incorporating diabetes prevention screening and referral into practice
  • An overview of the proven diabetes prevention program

Tools to engage patients:

  • A prediabetes risk test for patients to learn about their risk and help care teams identify patients at great risk
  • Posters and brochures for use in waiting areas to increase awareness and pave the way for conversations about screening, testing and referral (available in English and Spanish)
  • Patient handouts for use in the exam room after screening has revealed that a patient has prediabetes
  • Sample email and phone script

Download the Prevent Diabetes STAT Toolkit

Practice change tools and guides

Prediabetes guidelines of care

Guidelines of care provide recommendations based on the best available evidence to help health care teams design and deliver the best health care possible.

Lifestyle change guidelines of care

Patients diagnosed with diabetes or prediabetes can modify lifestyle behaviors to achieve 5 percent weight loss, which can prevent or reduce the impact of the disease. The following resources from the Institute for Clinical Systems Improvement (ICSI) can help your team design and incorporate evidence based screening and counseling for healthy lifestyle change and weight loss into your practice. Non-ICSI members can purchase the following guidelines.

Other best practices to improve prediabetes care

Seeking reimbursement for prediabetes care

Medicare provides reimbursement for diabetes screening and weight loss counseling. Medicare and Medicaid provide reimbursement for the DPP. Learn more about what each program provides reimbursement for below.

Medicare reimbursement for clinical care

Medicare recommends and provides coverage for diabetes screening tests through Part B Preventive Services for beneficiaries at risk for diabetes or those diagnosed with prediabetes. Find more information at: NIDDK Reimbursement and Coding for Prediabetes Screening.

The Centers for Medicare and Medicaid Services (CMS) details the correct procedure and diagnosis codes to receive Medicare reimbursement in their Physician Quality Reporting Initiative (PDF). This information is to be used by qualified Medicare fee-for-service health providers.

Medicare covers intensive behavioral counseling and behavioral therapy to promote sustained weight loss for beneficiaries. Many Medicare patients with prediabetes are eligible for this benefit. To obtain Medicare reimbursement, the counselor must be a primary health care provider delivering the counseling interventions in a health care setting.

To learn more, see Medicare’s guide for Intensive Behavioral Therapy (IBT) for Obesity (PDF).

Medicaid and Medicare reimbursement for the Diabetes Prevention Program

Minnesota Medicaid coverage for the DPP

The Minnesota Department of Human Services (DHS) provides coverage for Medicaid beneficiaries to attend a CDC-certified DPP. Learn more about eligible providers and recipients, and billing, on the Physician and Professional Services page, using code 0403T for the DPP.

Billing and coding for the DPP

On their Preventing Type 2 Diabetes page, the Twin Cities Medical Society (TCMS) offers a tip sheet about Medicaid billing and coding and documentation requirements for prediabetes screening and counseling for diabetes risks and healthy lifestyle change.

TCMS also provides contact information for the major Minnesota health plans’ provider/claims services departments, where you can learn more about their DPP coding, eligibility, benefits, claims and billing.

Medicare Diabetes Prevention Program (MDPP)

The U.S. Centers for Medicare and Medicaid (CMS) now provides reimbursement for individuals covered by Medicare Part B. Medicare payments for individuals will vary with a maximum payment of $670 per beneficiary over 2 years, depending on beneficiaries’ attendance and weight loss. See the Medicare Diabetes Prevention Program (MDPP) Expanded Model Fact Sheet (PDF) to learn which beneficiaries are eligible for the DPP and the requirements to become a MDPP Supplier.

How to enroll to become a Medicare Diabetes Prevention Program (MDPP) Supplier

DPP providers seeking Medicare reimbursement can refer to CMS's Medicare Diabetes Prevention Program Enrollment Fact Sheet (PDF).

For an orientation to the enrollment steps, review and follow the MDPP Supplier Road Map (PDF).

Standard Process for becoming a MDPP provider

  • First obtain a National Provider Identification Number (NPI), before completing and submitting an application to become a Medicare fee-for-service contractor. An NPI is required to bill CMS for services. To obtain an NPI, apply online with the National Plan & Provider Enumeration System.
  • Pay the required application fee via at initial enrollment, before submitting an application to the Medicare fee-for-service contractor.
  • Enroll with the Centers for Medicare and Medicaid (CMS) to become a Part B contractor. To apply for initial enrollment or make changes in your enrollment information using either the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) or the paper enrollment application process.

For additional information regarding the Medicare enrollment process, including Internet-based PECOS, go to Medicare Provider Supplier Enrollment.

Engaging patients in lifestyle change

Engage patients who are newly diagnosed with prediabetes

The health care team can engage newly diagnosed patients in a discussion about prediabetes. Find more information on what to say, and what not to say, on How to Talk with Patients about Their Prediabetes Diagnosis from NIDDK.

Make a personalized plan for change

Patients’ goals for lifestyle change will vary. Health care teams and patients need to co-create an evidence-based plan for change. Find tips and tools to work with your patients to develop a personal plan on NIDDK’s Develop a Personal Plan Based on Evidence page.

Recommend the DPP

Many health care, community and worksite settings in Minnesota offer the DPP. Find a Diabetes Program to recommend to your patients who have prediabetes or are at high risk for type 2 diabetes.

Recommend resources for patients not ready to enroll in the Diabetes Prevention Program

Not every person with a new prediabetes diagnosis will be ready to commit to participating in the DPP. The NIDDK has helpful information: Your Game Plan to Prevent Type 2 Diabetes. There you’ll find tools for setting personal goals and tracking progress.

Resources to promote lifestyle change

Once patients are ready to prevent type 2 diabetes through lifestyle changes, they will likely need support to reach their goals. You may choose to provide this support directly or refer patients to resources or intervention programs designed to support their efforts. Find more information on how to support your patients on Support Your Patients with Resources and Referrals from NIDDK.

Patient education materials

NIDDK has several helpful materials available to order on their Clinical Tools, Patient Education, & Outreach page, and their Diabetes HealthSense page provides easy access to resources to help patients live well and make healthy lifestyle change.

Health coaching for lifestyle change

Health coaching helps patients build the knowledge, skills and confidence to manage their condition and improve their health. Any member of the health care team can learn these skills and use them to engage patients.

The University of California San Francisco Center for Excellence in Primary Care provides helpful information on Health Coaching, including a training curriculum, videos and more.