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Wisconsin 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 $95 · 10th–90th $52–$2690%10%20%10th90th$95Professionalmedian $83 · 10th–90th $48–$1320%10%10th90th$83$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
$95.50 / $95.50 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $74.13 / $104.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $83.18 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $316.23 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $104.71 / $141.25
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $95.50 / $144.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $93.33 / $147.91
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $97.72 / $363.08
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
$141.25 / $141.25 / $141.25
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $123.03 / $181.97
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $363.08
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $117.49 / $363.08
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $72.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $83.18 / $181.97