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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

Facilitymedian $20 · 10th–90th $13–$320%10%10th90th$20Professionalmedian $20 · 10th–90th $12–$760%5%10%10th90th$20$10.0$20.0$50.0$100.0$200.0

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
$10.96 / $10.96 / $10.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $19.05 / $77.62
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.05 / $25.70 / $36.31
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
Facility
Modifier
Typical Low / Median / Typical High
$13.18 / $19.50 / $34.67
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.18 / $19.50 / $32.36
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $79.43
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.91 / $27.54 / $27.54
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.05 / $21.88 / $37.15
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.20 / $24.55 / $35.48
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.77 / $9.77 / $9.77
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $21.38 / $38.90
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $144.54