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New York 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 $47 · 10th–90th $25–$740%10%10th90th$47Professionalmedian $62 · 10th–90th $37–$1320%10%10th90th$62$1.0$5.0$20.0$100.0$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
$25.12 / $38.90 / $74.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $47.86 / $74.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $58.88 / $102.33
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $58.88 / $58.88
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $58.88 / $91.20
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 / $95.50
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $52.48 / $213.80
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $95.50 / $138.04
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $70.79
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $70.79 / $138.04
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $91.20 / $165.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $60.26 / $371.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $95.50 / $281.84
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $43.65 / $60.26
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $69.18 / $112.20