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Washington 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
$11.10 / $11.10 / $11.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.10 / $15.30 / $76.76
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.99 / $75.00 / $75.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.39 / $34.86 / $122.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.55 / $11.55 / $11.55
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.88 / $27.62 / $40.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.45 / $24.48 / $40.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.10 / $27.75 / $28.14
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.50 / $32.02 / $38.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.39 / $27.32 / $36.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.75 / $24.29 / $213.06
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.77 / $6.77 / $76.00