go back

New Jersey 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 $62 · 10th–90th $43–$4570%20%10th90th$62Professionalmedian $55 · 10th–90th $33–$790%10%10th90th$55$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
$42.66 / $42.66 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $47.86 / $72.44
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $60.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $61.66
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $60.26
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $91.20 / $138.04
Horizon BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $331.13 / $660.69
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $64.57 / $89.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $58.88 / $114.82