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Tennessee 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 $363 · 10th–90th $112–$3630%50%10th$363Professionalmedian $66 · 10th–90th $48–$1050%10%20%10th90th$66$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
$112.20 / $112.20 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $64.57 / $102.33
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
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $363.08
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $467.74 / $467.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $41.69 / $51.29
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $70.79 / $114.82