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Michigan 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.52 / $77.52 / $78.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $70.68 / $78.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.55 / $11.55 / $89.04
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.52 / $77.52 / $77.52
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.61 / $77.52 / $98.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.50 / $16.50 / $24.75