Agnes Kelley, LPC, LCDC
Professional Counselor · Houston, TX 77054 · NPI 1083147243 · 2 payer files
73%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Agnes Kelley, LPC, LCDC $70.14 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 80 contract rows for this clinician and code, from $52.15 to $95.04; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston professional counselors, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $70.14median of 80 rows · $52.15–$95.04 | $96.33 | 73% | above 40% of 1,205 Houston professional counselors on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $100.31median of 80 rows · $76.78–$137.50 | $137.41 | 73% | above 31% of 1,207 Houston professional counselors on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston professional counselors, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | UnitedHealthcare — Optum Behavioral Health | $40.00 | $82.68 | 48% | not typically billed by professional counselors |
| Aetna — Texas (office visit and psychotherapy codes only) | $71.72median of 48 rows · $57.67–$89.65 | $82.68 | 87% | not typically billed by professional counselors | |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | UnitedHealthcare — Optum Behavioral Health | $80.00 | $138.62 | 58% | not typically billed by professional counselors |
| Aetna — Texas (office visit and psychotherapy codes only) | $121.25median of 24 rows · $102.01–$149.26 | $138.62 | 87% | not typically billed by professional counselors |
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 Agnes Kelley, LPC, LCDC performs these services, and they are kept out of the benchmark above.