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Washington 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
Facility
Modifier
Low / Median / High Price
$10.96 / $10.96 / $10.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $19.05 / $77.62
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 / $11.48
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $19.50 / $32.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $19.05 / $31.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $50.12 / $79.43
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $27.54 / $28.18
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $21.88 / $38.02
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $23.99 / $35.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $21.38 / $37.15
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $144.54