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Massachusetts 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 $12 · 10th–90th $12–$910%50%90th$12Professionalmedian $23 · 10th–90th $12–$720%10%10th90th$23$10.0$20.0$50.0$100.0$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 / $12.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $38.02 / $75.86
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.49 / $18.62 / $91.20
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $12.02
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.50 / $69.18 / $87.10
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.50 / $19.50 / $22.91
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.45 / $25.70 / $38.90
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.49 / $18.62 / $91.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.49 / $13.49 / $13.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.18 / $19.50 / $41.69