Lashaunda Miles, LCSW
Clinical Social Worker · Houston, TX 77095 · NPI 1144085770 · 1 payer file
75%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Lashaunda Miles, LCSW $72.07 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 20 contract rows for this clinician and code, from $50.96 to $93.79; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston clinical social workers, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $72.07median of 20 rows · $50.96–$93.79 | $96.33 | 75% | above 52% of 780 Houston clinical social workers on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $106.74median of 30 rows · $78.35–$137.24 | $137.41 | 78% | above 92% of 783 Houston clinical social workers on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston clinical social workers, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $74.63median of 12 rows · $65.85–$87.80 | $82.68 | 90% | not typically billed by clinical social workers |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $124.66median of 12 rows · $110.00–$146.66 | $138.62 | 90% | not typically billed by clinical social workers |
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 Lashaunda Miles, LCSW performs these services, and they are kept out of the benchmark above.