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Wisconsin 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 $69 · 10th–90th $13–$1100%20%10th90th$69Professionalmedian $30 · 10th–90th $12–$760%20%10th90th$30$0.2$1.0$5.0$20.0$100.0$500.0

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
$72.44 / $72.44 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $48.98 / $77.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.80 / $20.89 / $45.71
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $234.42 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $26.30 / $104.71
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $56.23 / $93.33
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $56.23 / $93.33
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.45 / $23.99 / $91.20
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $58.88 / $70.79
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $35.48 / $35.48
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $30.90 / $45.71
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.30 / $26.30 / $91.20
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.48 / $29.51 / $91.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18.20 / $18.20 / $18.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.49 / $20.89 / $44.67