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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.70 / $63.70 / $72.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.39 / $56.00 / $72.80
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.70 / $63.70 / $72.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.85 / $63.70 / $74.48
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.50 / $157.50 / $157.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.66 / $15.66 / $15.66
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.55 / $11.55 / $11.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.36 / $15.75 / $28.85