Marlene Cummings, L.AC
Acupuncturist · Houston, TX 77063 · NPI 1043760267 · 1 payer file
67%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Marlene Cummings, L.AC $64.45 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 40 contract rows for this clinician and code, from $52.75 to $75.83; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston acupuncturists, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $64.45median of 40 rows · $52.75–$75.83 | $96.33 | 67% | above 7% of 16 Houston acupuncturists on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $93.66median of 40 rows · $77.42–$110.19 | $137.41 | 68% | above 7% of 16 Houston acupuncturists on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston acupuncturists, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $65.65median of 12 rows · $57.93–$77.24 | $82.68 | 79% | not typically billed by acupuncturists |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $109.28median of 12 rows · $96.42–$128.56 | $138.62 | 79% | not typically billed by acupuncturists |
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 Marlene Cummings, L.AC performs these services, and they are kept out of the benchmark above.