Arbelia Roman, P.A
Physician Assistant · Houston, TX 77006 · NPI 1124431184
74%of Medicare
BCBSTX pays Arbelia Roman, P.A $71.26 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 physician assistants |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $71.26 | $96.33 | 74% | above 60% of 1,372 Houston physician assistants |
| 99214Office visit, established patient, moderate complexity | $104.39 | $137.41 | 76% | above 63% of 1,356 Houston physician assistants |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $226.31 | $317.92 | 71% | not typically billed by physician assistants |
| 72148MRI lumbar spine, without contrast | $135.65 | $192.38 | 71% | not typically billed by physician assistants |
| 74177CT abdomen and pelvis, with contrast | $60.13 | $300.72 | 20% | not typically billed by physician assistants |
| 77067Screening mammography, bilateral | $25.17 | $126.38 | 20% | not typically billed by physician assistants |
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 Arbelia Roman, P.A performs these services, and they are kept out of the benchmark above.