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South Carolina rates for HCPCS G9876

Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 7-9 under the MDPP Expanded Model (EM). A core maintenance session is an MDPP service that: (1) is furnished by an MDPP supplier during months 7 through 12 of the MDPP services period; (2) is approximately 1 hour in length; and (3) adheres to a CDC-approved DPP curriculum for maintenance sessions. The beneficiary did not achieve at least 5% weight loss (WL) from his/her baseline weight, as measured by at least one in-person weight measurement at a core maintenance session in months 7-9

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $38.02 / $79.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $18.20 / $162.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $21.88 / $21.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $11.48 / $15.49
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $42.66 / $104.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $15.85 / $26.92