Ronald Winter, M.D.
Family Medicine Physician · Houston, TX 77028 · NPI 1134145212 · 1 payer file
101%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Ronald Winter, M.D. $96.98 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. The file lists 8 contract rows for this clinician and code, from $73.56 to $120.41; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston family medicine physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $96.98median of 8 rows · $73.56–$120.41 | $96.33 | 101% | above 55% of 623 Houston family medicine physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $140.04median of 8 rows · $108.33–$171.76 | $137.41 | 102% | above 55% of 632 Houston family medicine physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston family medicine physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $93.60median of 8 rows · $83.86–$103.35 | $82.68 | 113% | not typically billed by family medicine 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 Ronald Winter, M.D. performs these services, and they are kept out of the benchmark above.