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Massachusetts 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 $49 · 10th–90th $37–$1020%10%20%10th90th$49Professionalmedian $60 · 10th–90th $37–$1380%5%10%10th90th$60$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
$38.02 / $38.02 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $51.29 / $81.28
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $162.18 / $257.04
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $74.13 / $169.82
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $44.67 / $102.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $60.26
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $45.71 / $72.44
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $87.10 / $131.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $81.28 / $162.18
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $162.18 / $257.04
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $74.13 / $169.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $186.21 / $194.98
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $79.43 / $169.82