Evelyn Paysse, M.D.
Pediatric Ophthalmology and Strabismus Specialist Physician · Houston, TX 77030 · NPI 1124017587
54%of Medicare
BCBSTX pays Evelyn Paysse, M.D. $51.98 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 pediatric ophthalmology and strabismus specialist physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $51.98 | $96.33 | 54% | above 39% of 24,819 all Houston clinicians |
| 99214Office visit, established patient, moderate complexity | $80.13 | $137.41 | 58% | above 26% of 24,759 all Houston clinicians |
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 pediatric ophthalmology and strabismus specialist physicians |
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by pediatric ophthalmology and strabismus specialist 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 Evelyn Paysse, M.D. performs these services, and they are kept out of the benchmark above.