Margot Ellard, CNM
Advanced Practice Midwife · Houston, TX 77054 · NPI 1033308523 · 1 payer file
77%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Margot Ellard, CNM $73.89 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 96 contract rows for this clinician and code, from $0.01 to $145.22; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston advanced practice midwifes, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $73.89median of 96 rows · $0.01–$145.22 | $96.33 | 77% | above 90% of 41 Houston advanced practice midwifes on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $109.51median of 94 rows · $0.01–$206.63 | $137.41 | 80% | above 92% of 40 Houston advanced practice midwifes on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston advanced practice midwifes, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $65.65median of 24 rows · $0.01–$77.25 | $82.68 | 79% | not typically billed by advanced practice midwifes |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $108.97median of 16 rows · $0.01–$136.21 | $138.62 | 79% | not typically billed by advanced practice midwifes |
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 Margot Ellard, CNM performs these services, and they are kept out of the benchmark above.