AMY Nelson
Physician Assistant · Houston, TX 77070 · NPI 1144831579 · 2 payer files
98%of Medicare
Cigna — Texas Connect (individual & family) pays AMY Nelson $94.00 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 $94.00 to $94.00; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston physician assistants, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Texas Connect (individual & family) | $94.00median of 2 rows · $94.00–$94.00 | $96.33 | 98% | above 74% of 58 Houston physician assistants on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $65.46median of 262 rows · $52.15–$83.23 | $96.33 | 68% | above 20% of 1,220 Houston physician assistants on this plan | |
| 99214Office visit, established patient, moderate complexity | Cigna — Texas Connect (individual & family) | $133.00median of 2 rows · $133.00–$133.00 | $137.41 | 97% | above 74% of 58 Houston physician assistants on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $95.14median of 238 rows · $76.78–$120.73 | $137.41 | 69% | above 19% of 1,217 Houston physician assistants on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston physician assistants, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Texas Connect (individual & family) | $73.00median of 2 rows · $73.00–$73.00 | $82.68 | 88% | not typically billed by physician assistants |
| Aetna — Texas (office visit and psychotherapy codes only) | $65.67median of 92 rows · $57.67–$79.86 | $82.68 | 79% | not typically billed by physician assistants | |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Texas Connect (individual & family) | $122.00median of 2 rows · $122.00–$122.00 | $138.62 | 88% | not typically billed by physician assistants |
| Aetna — Texas (office visit and psychotherapy codes only) | $115.61median of 72 rows · $102.01–$138.74 | $138.62 | 83% | 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 AMY Nelson performs these services, and they are kept out of the benchmark above.