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South Dakota 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
$76.76 / $76.76 / $76.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $76.76 / $84.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.55 / $84.00 / $105.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.94 / $142.57 / $231.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $27.00 / $91.15
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.02 / $23.89 / $32.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.44 / $22.86 / $25.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.75 / $26.78 / $31.50