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North Carolina 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
$70.00 / $70.00 / $70.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.85 / $70.00 / $74.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.58 / $26.42 / $100.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.66 / $15.66 / $15.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.55 / $11.55 / $11.55
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.80 / $16.50 / $84.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.09 / $18.00 / $19.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $129.50 / $157.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.50 / $17.25 / $38.11
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.99 / $77.05 / $77.05
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.15 / $118.80 / $118.80