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Pennsylvania 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 $63 · 10th–90th $22–$720%50%10th90th$63Professionalmedian $23 · 10th–90th $11–$760%10%20%10th90th$23$1.0$2.0$5.0$10.0$20.0$50.0$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
$63.10 / $63.10 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $51.29 / $75.86
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
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.62 / $18.62 / $18.62
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $63.10
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $52.48 / $77.62
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $0.60 / $158.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $15.14 / $26.92