Lindsey Wilson, CPNP-AC
Critical Care Pediatric Nurse Practitioner · Houston, TX 77030 · NPI 1093188609 · 1 payer file
109%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Lindsey Wilson, CPNP-AC $105.20 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 84 contract rows for this clinician and code, from $55.29 to $160.06; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston critical care pediatric nurse practitioners, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $105.20median of 84 rows · $55.29–$160.06 | $96.33 | 109% | above 95% of 40 Houston critical care pediatric nurse practitioners on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $162.26median of 84 rows · $81.20–$235.94 | $137.41 | 118% | above 95% of 41 Houston critical care pediatric nurse practitioners on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston critical care pediatric nurse practitioners, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $125.35median of 64 rows · $96.34–$145.33 | $82.68 | 152% | not typically billed by critical care pediatric nurse practitioners |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $210.56median of 64 rows · $162.03–$243.39 | $138.62 | 152% | not typically billed by critical care pediatric nurse practitioners |
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 Lindsey Wilson, CPNP-AC performs these services, and they are kept out of the benchmark above.