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California rates for HCPCS G9877

Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 10-12 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 10-12

Facilitymedian $21 · 10th–90th $12–$910%10%10th90th$21Professionalmedian $17 · 10th–90th $11–$780%10%20%10th90th$17$0.0$0.2$2.0$20.0$200.0

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
$12.02 / $12.02 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $26.92 / $75.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.75 / $14.45 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $12.02
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $14.45
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $257.04 / $831.76
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $117.49 / $117.49
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $60.26
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.30 / $19.95 / $91.20
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $13.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.13 / $14.13 / $14.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $16.22 / $38.90