Franciska Gudenkauf, MD, MPH
Gastroenterology Physician · Houston, TX 77030 · NPI 1053930990 · 1 payer file
111%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Franciska Gudenkauf, MD, MPH $106.62 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 36 contract rows for this clinician and code, from $60.93 to $142.16; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston gastroenterology physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $106.62median of 36 rows · $60.93–$142.16 | $96.33 | 111% | above 52% of 214 Houston gastroenterology physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $154.56median of 36 rows · $93.57–$206.08 | $137.41 | 112% | above 52% of 214 Houston gastroenterology physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston gastroenterology physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $115.25median of 20 rows · $97.28–$135.60 | $82.68 | 139% | not typically billed by gastroenterology physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $203.90median of 12 rows · $179.91–$239.89 | $138.62 | 147% | not typically billed by gastroenterology 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 Franciska Gudenkauf, MD, MPH performs these services, and they are kept out of the benchmark above.