David Portugal, MD, FACC
Cardiovascular Disease Physician · Houston, TX 77074 · NPI 1114030343 · 1 payer file
103%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays David Portugal, MD, FACC $99.25 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 32 contract rows for this clinician and code, from $84.80 to $116.98; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston cardiovascular disease physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $99.25median of 32 rows · $84.80–$116.98 | $96.33 | 103% | above 65% of 233 Houston cardiovascular disease physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $144.45median of 32 rows · $124.11–$174.18 | $137.41 | 105% | above 65% of 233 Houston cardiovascular disease physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston cardiovascular disease physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $90.16median of 12 rows · $79.55–$106.08 | $82.68 | 109% | not typically billed by cardiovascular disease 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 David Portugal, MD, FACC performs these services, and they are kept out of the benchmark above.