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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

Facilitymedian $18 · 10th–90th $14–$790%20%10th90th$18Professionalmedian $16 · 10th–90th $11–$760%10%20%10th90th$16$0.0$0.2$2.0$20.0$200.0$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
$15.85 / $15.85 / $15.85
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $19.05 / $77.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.02 / $6.76
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.18 / $16.60 / $24.55
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.18 / $25.70 / $102.33
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $12.02
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.45 / $17.38 / $25.70
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.45 / $17.38 / $25.70
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.22 / $14.13 / $19.50
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.22 / $15.85 / $26.92