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Illinois rates for HCPCS G0245

Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) which must include: (1) the diagnosis of LOPS, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot, and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (4) patient education

Facilitymedian $204 · 10th–90th $35–$3020%10%20%10th90th$204Professionalmedian $58 · 10th–90th $37–$910%10%10th90th$58$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $38.90 / $63.10
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $48.98 / $72.44
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $53.70
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $239.88 / $302.00
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $70.79 / $91.20
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $72.44
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $79.43 / $128.82
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $48.98 / $83.18
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $95.50
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.02 / $354.81 / $512.86
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $64.57 / $102.33