Abhay Kumar, MD
Neurocritical Care Physician · Houston, TX 77030 · NPI 1093942708
95%of Medicare
BCBSTX pays Abhay Kumar, MD $91.45 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.
Negotiated rates vs Medicare
| Service | BCBSTX | Medicare | % of Medicare | Among Houston neurocritical care physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $91.45 | $96.33 | 95% | above 67% of 16 Houston neurocritical care physicians |
| 99214Office visit, established patient, moderate complexity | $133.97 | $137.41 | 97% | above 33% of 16 Houston neurocritical care physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $88.84 | $317.92 | 28% | not typically billed by neurocritical care physicians |
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by neurocritical care physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by neurocritical care 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 Abhay Kumar, MD performs these services, and they are kept out of the benchmark above.