Lauren Bailey, PHARMD
Oncology Pharmacist · Houston, TX 77054 · NPI 1083269716 · 1 payer file
132%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Lauren Bailey, PHARMD $127.21 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 42 contract rows for this clinician and code, from $64.34 to $171.30; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston oncology pharmacists, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $127.21median of 42 rows · $64.34–$171.30 | $96.33 | 132% | above 84% of 21,862 all Houston clinicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $180.69median of 28 rows · $77.54–$242.38 | $137.41 | 131% | above 86% of 21,418 all Houston clinicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston oncology pharmacists, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $104.36median of 12 rows · $92.08–$122.77 | $82.68 | 126% | not typically billed by oncology pharmacists |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $215.24median of 8 rows · $197.78–$232.69 | $138.62 | 155% | not typically billed by oncology pharmacists |
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 Lauren Bailey, PHARMD performs these services, and they are kept out of the benchmark above.