AMY Middleman, MD
Pediatric Adolescent Medicine Physician · Houston, TX 77030 · NPI 1063592475 · 1 payer file
93%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays AMY Middleman, MD $89.88 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 48 contract rows for this clinician and code, from $65.69 to $120.10; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatric adolescent medicine physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $89.88median of 48 rows · $65.69–$120.10 | $96.33 | 93% | above 42% of 13 Houston pediatric adolescent medicine physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $131.00median of 64 rows · $96.83–$170.70 | $137.41 | 95% | above 42% of 13 Houston pediatric adolescent medicine physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatric adolescent medicine physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $102.26median of 42 rows · $80.91–$122.81 | $82.68 | 124% | not typically billed by pediatric adolescent medicine physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $171.31median of 28 rows · $135.61–$205.06 | $138.62 | 124% | not typically billed by pediatric adolescent medicine 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 AMY Middleman, MD performs these services, and they are kept out of the benchmark above.