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Virginia 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
$16.50 / $16.50 / $72.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $16.50 / $72.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $6.77
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.37 / $16.71 / $24.29
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.00 / $18.55 / $93.02
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $24.66 / $33.02
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.59 / $17.80 / $27.12
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.59 / $17.80 / $27.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.80 / $15.92 / $26.78