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Maine 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 $13 · 10th–90th $13–$130%50%100%$13Professionalmedian $21 · 10th–90th $12–$720%10%10th90th$21$5.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $19.05 / $75.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.75 / $6.76 / $8.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $12.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.79 / $23.99 / $42.66
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $43.65 / $77.62
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.49 / $19.95 / $39.81