Claudia Soto DE LA Cerda, MD PHD
Psychiatry Physician · Houston, TX 77021 · NPI 1104408145
95%of Medicare
BCBSTX pays Claudia Soto DE LA Cerda, MD PHD $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 psychiatry physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $91.45 | $96.33 | 95% | above 74% of 357 Houston psychiatry physicians |
| 99214Office visit, established patient, moderate complexity | $133.97 | $137.41 | 97% | above 82% of 357 Houston psychiatry physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $251.39 | $317.92 | 79% | not typically billed by psychiatry physicians |
| 72148MRI lumbar spine, without contrast | $54.11 | $192.38 | 28% | not typically billed by psychiatry 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 Claudia Soto DE LA Cerda, MD PHD performs these services, and they are kept out of the benchmark above.