Norma Rivera-opio, M.D.
Internal Medicine Physician · Houston, TX 77091 · NPI 1093767410 · 1 payer file
62%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Norma Rivera-opio, M.D. $59.67 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 56 contract rows for this clinician and code, from $45.85 to $81.60; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston internal medicine physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $59.67median of 56 rows · $45.85–$81.60 | $96.33 | 62% | above 2% of 898 Houston internal medicine physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $88.78median of 50 rows · $67.55–$118.37 | $137.41 | 65% | above 2% of 899 Houston internal medicine physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston internal medicine physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $58.73median of 36 rows · $49.24–$78.30 | $82.68 | 71% | not typically billed by internal medicine physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $102.01median of 36 rows · $86.70–$136.02 | $138.62 | 74% | not typically billed by internal medicine 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 Norma Rivera-opio, M.D. performs these services, and they are kept out of the benchmark above.