Paul Shay, M.D.
Plastic and Reconstructive Surgery Physician · Houston, TX 77030 · NPI 1063807436
134%of Medicare
BCBSTX pays Paul Shay, M.D. $129.07 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.
Negotiated rates vs Medicare
| Service | BCBSTX | Medicare | % of Medicare | Among Houston plastic and reconstructive surgery physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $129.07 | $96.33 | 134% | above 75% of 69 Houston plastic and reconstructive surgery physicians |
| 99214Office visit, established patient, moderate complexity | $189.08 | $137.41 | 138% | above 79% of 69 Houston plastic and reconstructive surgery physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 74177CT abdomen and pelvis, with contrast | $125.18 | $300.72 | 42% | not typically billed by plastic and reconstructive surgery physicians |
| 77067Screening mammography, bilateral | $186.80 | $126.38 | 148% | not typically billed by plastic and reconstructive surgery 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 Paul Shay, M.D. performs these services, and they are kept out of the benchmark above.