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Texas 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 $36 · 10th–90th $13–$950%10%10th90th$36Professionalmedian $38 · 10th–90th $11–$760%20%10th90th$38$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$38.02 / $38.02 / $43.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $51.29 / $75.86
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $79.43
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
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $117.49 / $117.49
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $28.18 / $100.00
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $51.29 / $75.86
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $1,995.26 / $1,995.26
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $158.49 / $158.49
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $25.12 / $97.72
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $12.02
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.22 / $14.13 / $20.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $15.85 / $25.70
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.76 / $75.86 / $95.50