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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

Facilitymedian $71 · 10th–90th $14–$1020%20%10th90th$71Professionalmedian $19 · 10th–90th $12–$1000%20%10th90th$19$0.2$1.0$5.0$20.0$100.0

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
$70.79 / $70.79 / $109.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $52.48 / $77.62
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $18.20 / $100.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21.88 / $21.88 / $21.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $12.02
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.80 / $70.79 / $97.72
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $0.60 / $0.60
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.60 / $16.60 / $16.60
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $16.60 / $29.51
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $117.49 / $117.49