Lindsay Kilburn, MD
Pediatric Hematology & Oncology Physician · Houston, TX 77030 · NPI 1023215944 · 1 payer file
147%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Lindsay Kilburn, MD $141.47 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 32 contract rows for this clinician and code, from $94.08 to $225.33; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatric hematology & oncology physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $141.47median of 32 rows · $94.08–$225.33 | $96.33 | 147% | above 96% of 132 Houston pediatric hematology & oncology physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $207.89median of 32 rows · $144.84–$316.41 | $137.41 | 151% | above 95% of 132 Houston pediatric hematology & oncology physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatric hematology & oncology physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $133.79median of 32 rows · $102.15–$167.86 | $82.68 | 162% | not typically billed by pediatric hematology & oncology physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $225.05median of 32 rows · $172.14–$278.47 | $138.62 | 162% | not typically billed by pediatric hematology & oncology 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 Lindsay Kilburn, MD performs these services, and they are kept out of the benchmark above.