Brian Shelton, MD, CSA
Surgical Assistant · Houston, TX 77005 · NPI 1124495858 · 2 payer files
89%of Medicare
Cigna — Houston FlexCare pays Brian Shelton, MD, CSA $85.41 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 2 contract rows for this clinician and code, from $72.07 to $98.74; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston surgical assistants, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Houston FlexCare | $85.41median of 2 rows · $72.07–$98.74 | $96.33 | 89% | above 65% of 858 all Houston clinicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $58.19median of 8 rows · $44.13–$72.24 | $96.33 | 60% | above 2% of 21,862 all Houston clinicians on this plan | |
| 99214Office visit, established patient, moderate complexity | Cigna — Houston FlexCare | $123.03median of 2 rows · $106.40–$139.65 | $137.41 | 90% | above 18% of 858 all Houston clinicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $84.03median of 8 rows · $65.00–$103.05 | $137.41 | 61% | above 1% of 21,418 all Houston clinicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston surgical assistants, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Houston FlexCare | $82.08median of 2 rows · $77.47–$86.69 | $82.68 | 99% | not typically billed by surgical assistants |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Houston FlexCare | $137.98median of 2 rows · $130.43–$145.52 | $138.62 | 100% | not typically billed by surgical assistants |
| 70553MRI brain, with and without contrast | Cigna — Houston FlexCare | $304.38 | $317.92 | 96% | not typically billed by surgical assistants |
| 72148MRI lumbar spine, without contrast | Cigna — Houston FlexCare | $182.18 | $192.38 | 95% | not typically billed by surgical assistants |
| 74177CT abdomen and pelvis, with contrast | Cigna — Houston FlexCare | $290.72 | $300.72 | 97% | not typically billed by surgical assistants |
| 77067Screening mammography, bilateral | Cigna — Houston FlexCare | $117.58 | $126.38 | 93% | not typically billed by surgical 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 Brian Shelton, MD, CSA performs these services, and they are kept out of the benchmark above.