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Wisconsin rates for HCPCS G0501

Resource-intensive services for patients for whom the use of specialized mobility-assistive technology (such as adjustable height chairs or tables, patient lift, and adjustable padded leg supports) is medically necessary and used during the provision of an office/outpatient, evaluation and management visit (list separately in addition to primary service)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.07 / $18.07 / $18.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.07 / $18.07 / $18.07
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.07 / $18.07 / $27.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.07 / $18.07 / $32.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.07 / $18.07 / $27.12
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $100.00