Suzanne Adams, RN, IBCLC
Lactation Consultant (Registered Nurse) · Houston, TX 77095 · NPI 1013126994 · 1 payer file
54%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Suzanne Adams, RN, IBCLC $52.14 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 60 contract rows for this clinician and code, from $37.70 to $73.38; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston lactation consultant (registered nurse)s, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $52.14median of 60 rows · $37.70–$73.38 | $96.33 | 54% | above 0% of 11 Houston lactation consultant (registered nurse)s on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $80.13median of 60 rows · $57.97–$107.83 | $137.41 | 58% | above 0% of 13 Houston lactation consultant (registered nurse)s on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston lactation consultant (registered nurse)s, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $50.02median of 48 rows · $40.74–$64.12 | $82.68 | 60% | not typically billed by lactation consultant (registered nurse)s |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $84.11median of 48 rows · $68.64–$107.68 | $138.62 | 61% | not typically billed by lactation consultant (registered nurse)s |
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 Suzanne Adams, RN, IBCLC performs these services, and they are kept out of the benchmark above.