Blog Viewer

CMS Finalizes Payment and MDPP and MNT Policy Changes for 2022

By Kate Thomas posted 11-23-2021 10:05


On November 2, the Centers for Medicare & Medicaid Services (CMS) released the Medicare Physician Fee Schedule (MPFS) final rule for calendar year 2022, which outlines the Medicare payment rates for 2022 and addresses other provisions including updates to the Medicare Diabetes Prevention Program (MDPP) and the Medical Nutrition Therapy (MNT) benefit. The changes apply to Medicare Part B services furnished on or after January 1, 2022.

ADCES has highlighted key provisions that may be of interest to members. Additional information can be found on the CMS fact sheet. There is also a separate fact sheet detailing proposed changes to the MDPP.

Payment Conversion Factor

CMS has finalized a conversion factor of $33.59, a decrease of $1.30 from the CY 2021 conversion factor of $34.89. The conversion factor is used to calculate the payment rate for services paid under the MPFS. The decrease in payment is due to a 3.75% payment increase set to expire at the end of 2021. Groups, including ADCES, are urging Congress to act to prevent the cut to the conversion factor to take effect.

Valuation for Diabetes Self-Management Training (DSMT) Codes (G0108 and G0109)

CMS did not propose any changes to the DSMT benefit or related codes- G0108 (Diabetes outpatient self-management training services, individual, 30 minutes) and G0109 (Diabetes outpatient self-management training services, group session (2 or more patients), per 30 minutes). See Table 1 for the estimated payment rates for 2022. Note, Congress may intervene to prevent the payment cuts from taking effect.

Table 1:



Estimated 2022














ADCES continues to advocate for changes to the DSMT benefit both through our legislative efforts in advancing the Expanding Access to DSMT Act (S. 2203, H.R. 5804) and through ongoing discussions with and comments to CMS. ADCES urges its members to contact their legislators and ask them to support this important legislation.  

Medicare Diabetes Prevention Program

ADCES, in collaboration with other stakeholders including the Diabetes Advocacy Alliance (DAA), has been and continues to advocate for improvements to the MDPP. Through written communications, formal comment letters, engagement with congressional leaders, meetings, and other channels, ADCES and the DAA have urged CMS and the Center for Medicare and Medicaid Innovation (CMMI) to remove the barriers that suppliers face when trying to enroll in and/or deliver the MDPP. We have also addressed challenges that limit beneficiary access to the program. In the final rule, CMS finalized a series of significant changes to help reduce the administrative burden on suppliers and improve beneficiary access to the services.

Below is a summary of the MDPP changes for 2022:

  • Waiving the Provider Enrollment Fee: CMS finalized a policy to waive the $599 provider enrollment application fee for all organizations that submit an application to enroll as an MDPP supplier on or after January 1, 2022.
  • Shorten the MDPP Services Period to One Year: CMS finalized a provision to shorten the MDPP services period to from two years to one year by removing the Ongoing Maintenance sessions phase (months 13-24) of the MDPP set of services. This would apply to beneficiaries starting the MDPP on or after January 1, 2022 and would align with the National DPP. Medicare beneficiaries who began the program in 2021 or who were in ongoing maintenance classes in 2021 will have the option to continuing year 2.
  • Redistributing Payments: As CMS is now removing the Ongoing Maintenance sessions from the MDPP services period, they also finalized a provision to redistribute a portion of the Ongoing Maintenance session phase performance payments to certain Core and Core Maintenance performance payments. They also propose to increase performance payments for MDPP beneficiary achievement of the 5% weight loss goal, as well as continued attendance during each core maintenance interval. The total available payment amount for 2022 is $705

ADCES is pleased that CMS has put forward these proposed changes, especially as it reflects our extensive advocacy work to push for program improvements that would make it easier for suppliers/providers to delivery MDPP services. Though an important start, additional changes are needed, especially the need to address the 5 percent weight loss threshold and other disincentives in the current model for serving lower income and marginalized populations. ADCES has also advocated for the removal of the once-per-lifetime limit and the inclusion of virtual programs as MDPP suppliers to help improve equitable access and expand reach of the program.

Medical Nutrition Therapy

CMS also finalized updates to the regulation for MNT, including the following:

  • CMS removed the requirement that the MNT referral be made by the “treating physician.” Prior to this change, CMS regulations required the MNT referral to come from the treating physician, who they define as the primary care physician or specialist, coordinating care for the beneficiary with diabetes or renal disease. Though the revised policy still does not include non-physician providers, we are hopeful that it will help improve beneficiary access to MNT and will continue to work with others, including the Academy of Nutrition and Dietetics to increase the list of referring providers.
  • CMS made technical corrections and updated the payment regulation for MNT services at §414.64 to clarify that MNT services are, and have been, paid at 100% (instead of 80%) of 85% of the PFS amount, without any cost-sharing, since CY 2011.
  • CMS finalized the provision to update the glomerular filtration rate (GFR) to reflect current medical practice. They are updating the regulation (§ 410.130) by revising the chronic renal insufficiency definition by removing the GFR eligibility criteria of 13 – 50 ml/min/1.73m2 and replacing with 15 – 59ml/min/1.73m2. This is an important update for beneficiaries with chronic kidney disease receiving MNT services and helps to align the beneficiary’s GFR and Medicare eligibility criteria.
  • CMS established regulations at §410.72 for registered dietitians and nutrition professionals, similar to established regulations for other non-physician practitioners.