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Tennessee 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
$26.78 / $26.78 / $26.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.10 / $16.35 / $77.52
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.99 / $75.00 / $77.05
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.15 / $91.15 / $118.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.75 / $17.61 / $31.58