Franklin Newman, LMSW
Social Worker · Houston, TX 77030 · NPI 1073043253 · 1 payer file
75%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Franklin Newman, LMSW $72.25 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 62 contract rows for this clinician and code, from $53.11 to $109.93; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston social workers, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $72.25median of 62 rows · $53.11–$109.93 | $96.33 | 75% | above 50% of 69 Houston social workers on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $94.84median of 64 rows · $76.90–$159.65 | $137.41 | 69% | above 4% of 69 Houston social workers on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston social workers, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $75.03median of 48 rows · $55.28–$105.60 | $82.68 | 91% | not typically billed by social workers |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $122.70median of 56 rows · $92.58–$185.26 | $138.62 | 89% | not typically billed by social workers |
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 Franklin Newman, LMSW performs these services, and they are kept out of the benchmark above.