Thomas LUX, M.D.
Internal Medicine Physician · Houston, TX 77005 · NPI 1003834409 · 2 payer files
102%of Medicare
Cigna — Houston FlexCare pays Thomas LUX, M.D. $98.72 for a 99213 — Office visit, established patient, low complexity. Medicare pays $96.33 for the same service in this locality. Commercial insurance is widely assumed to pay above Medicare. The file lists 2 contract rows for this clinician and code, from $83.64 to $113.80; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston internal medicine physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Houston FlexCare | $98.72median of 2 rows · $83.64–$113.80 | $96.33 | 102% | above 88% of 67 Houston internal medicine physicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $87.06median of 8 rows · $72.79–$101.33 | $96.33 | 90% | above 43% of 898 Houston internal medicine physicians on this plan | |
| 99214Office visit, established patient, moderate complexity | Cigna — Houston FlexCare | $142.53median of 2 rows · $123.57–$161.49 | $137.41 | 104% | above 88% of 67 Houston internal medicine physicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $131.09median of 8 rows · $111.90–$150.29 | $137.41 | 95% | above 44% of 899 Houston internal medicine physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston internal medicine physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Houston FlexCare | $83.07median of 2 rows · $78.33–$87.81 | $82.68 | 100% | not typically billed by internal medicine physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Houston FlexCare | $139.38median of 2 rows · $131.62–$147.13 | $138.62 | 101% | not typically billed by internal medicine physicians |
| 70553MRI brain, with and without contrast | Cigna — Houston FlexCare | $372.71 | $317.92 | 117% | not typically billed by internal medicine physicians |
| 72148MRI lumbar spine, without contrast | Cigna — Houston FlexCare | $222.09 | $192.38 | 115% | not typically billed by internal medicine physicians |
| 74177CT abdomen and pelvis, with contrast | Cigna — Houston FlexCare | $348.69 | $300.72 | 116% | not typically billed by internal medicine physicians |
| 77067Screening mammography, bilateral | Cigna — Houston FlexCare | $138.09 | $126.38 | 109% | not typically billed by internal medicine physicians |
A payer’s file carries a rate for every code in the contract’s fee class, whether or not the clinician will ever bill it. These rows are real, and they are how the fee class shows through — but they are not evidence that Thomas LUX, M.D. performs these services, and they are kept out of the benchmark above.