go back

New York rates for HCPCS G9878

Two Medicare Diabetes Prevention Program (MDPP) core maintenance sessions (MS) were attended by an MDPP beneficiary in months (mo) 7-9 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 achieved 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 7-9

Facilitymedian $60 · 10th–90th $31–$870%20%10th90th$60Professionalmedian $63 · 10th–90th $40–$1020%10%20%10th90th$63$0.0$0.1$0.5$2.0$10.0$50.0$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
$30.90 / $30.90 / $74.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $67.61 / $102.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.03 / $26.92
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $47.86 / $47.86
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $61.66
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $60.26 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $60.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $63.10 / $128.82
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $58.88 / $61.66
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $58.88 / $100.00