THE MDPP BENEFICIARY ACHIEVED AT LEAST 5% WEIGHT LOSS (WL) FROM HIS/HER BASELINE WEIGHT IN MONTHS 1-12 OF THE MDPP SERVICES PERIOD UNDER THE MDPP EXPANDED MODEL (EM). THIS IS A ONE-TIME PAYMENT AVAILABLE WHEN A BENEFICIARY FIRST ACHIEVES AT LEAST 5% WEIG

Payers reporting HCPCS G9880

Payer pricing summary

Low

Average

$249

Median

$190

High

$1.1k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +16 other terms	52	$298	$287	$140	49%	—	$42 – $791
2	Humana fee schedule · outpatient · +18 other terms	51	$1.1k	$972	$564	58%	—	$82 – $1.6k
3	Aetna fee schedule · outpatient · +16 other terms	24	$167	$275	$298	108%	—	$79 – $1.6k
4	Cigna professional · fee schedule · both · +12 other terms	15	$150	$127	$97	77%	—	$0 – $276
5	Blue Cross Blue Shield facility · fee schedule · outpatient · +10 other terms	13	$160	$146	$28	19%	—	$62 – $160
6	Molina facility · case rate · outpatient · +18 other terms	13	$43	$46	$11	25%	—	$36 – $83
7	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$507	$382	$217	57%	—	$160 – $635
8	Highmark fee schedule · outpatient · +7 other terms	11	$175	$175	$10	6%	—	$81 – $177
9	Medica fee schedule · outpatient · +5 other terms	10	$302	$303	$78	26%	—	$183 – $390
10	Ambetter other · outpatient · +4 other terms	8	$1.7k	$1.7k	$100	6%	—	$1.3k – $1.8k
11	Anthem other · outpatient · +10 other terms	8	$870	$870	—	—	—	$870 – $870
12	First Health professional · fee schedule · both · +9 other terms	8	$0	$67	$86	129%	—	$0 – $178
13	WellCare professional · fee schedule · both · +5 other terms	8	$0	$0	—	—	—	$0 – $0
14	Aetna Better Health fee schedule · inpatient · +6 other terms	7	$190	$190	—	—	—	$190 – $190
15	Amerihealth Caritas facility · case rate · outpatient · +3 other terms	7	$40	$40	$1	3%	—	$40 – $43
16	Bcbs Il professional · fee schedule · both · +2 other terms	7	$0	$0	—	—	—	$0 – $0
17	Caresource other · outpatient · +4 other terms	6	$1.6k	$1.6k	$65	4%	—	$1.6k – $1.7k
18	MultiPlan professional · fee schedule · both · +4 other terms	3	$0	$79	$112	141%	—	$0 – $237
19	Phcs professional · fee schedule · both · +2 other terms	3	$0	$79	$112	141%	—	$0 – $237
20	Wellmark facility · case rate · outpatient	3	$140	$123	$39	32%	—	$57 – $155
21	Carefirst professional · fee schedule · inpatient · +2 other terms	2	$149	$149	—	—	—	$149 – $149
22	Clover facility · other · outpatient	2	$414	$414	$39	9%	—	$375 – $453
23	Excellus professional · fee schedule · inpatient · +3 other terms	2	$149	$149	—	—	—	$149 – $149
24	Kaiser professional · fee schedule · inpatient · +4 other terms	2	$149	$149	—	—	—	$149 – $149
25	Magellan professional · fee schedule · inpatient · +1 other terms	2	$149	$149	—	—	—	$149 – $149

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