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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.80 / $74.40 / $84.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.60 / $64.26 / $96.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.03 / $26.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.26 / $62.26 / $62.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.92 / $45.92 / $45.92
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.26 / $51.26 / $61.00
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.84 / $59.98 / $125.99
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.26 / $62.26 / $62.26
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.92 / $45.92 / $45.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.19 / $66.15 / $160.83
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.26 / $59.19 / $61.00
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.53 / $59.98 / $129.44