Madison Simon, CPNP-BC
Pediatric Nurse Practitioner · Houston, TX 77027 · NPI 1154898450 · 1 payer file
62%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Madison Simon, CPNP-BC $60.03 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 $55.66 to $75.04; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatric nurse practitioners, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $60.03median of 20 rows · $55.66–$75.04 | $96.33 | 62% | above 4% of 222 Houston pediatric nurse practitioners on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $85.94median of 24 rows · $79.53–$106.04 | $137.41 | 63% | above 3% of 221 Houston pediatric nurse practitioners on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatric nurse practitioners, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $73.96median of 12 rows · $65.27–$87.02 | $82.68 | 89% | not typically billed by pediatric nurse practitioners |
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 Madison Simon, CPNP-BC performs these services, and they are kept out of the benchmark above.