Clarice Anthony-francis
Professional Counselor · Houston, TX 77008 · NPI 1033752522 · 1 payer file
61%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Clarice Anthony-francis $58.95 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 28 contract rows for this clinician and code, from $47.00 to $69.35; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston professional counselors, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $58.95median of 28 rows · $47.00–$69.35 | $96.33 | 61% | above 1% of 1,205 Houston professional counselors on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $85.51median of 30 rows · $69.02–$100.61 | $137.41 | 62% | above 0% of 1,207 Houston professional counselors on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston professional counselors, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $56.57median of 12 rows · $49.92–$66.55 | $82.68 | 68% | not typically billed by professional counselors |
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 Clarice Anthony-francis performs these services, and they are kept out of the benchmark above.