Andrea James, PA-C
Physician Assistant · Houston, TX 77074 · NPI 1184180374 · 1 payer file
80%of Medicare
UnitedHealthcare — Optum Behavioral Health pays Andrea James, PA-C $77.20 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.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston physician assistants, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | UnitedHealthcare — Optum Behavioral Health | $77.20 | $96.33 | 80% | above 11% of 19 Houston physician assistants on this plan |
| 99214Office visit, established patient, moderate complexity | UnitedHealthcare — Optum Behavioral Health | $109.17 | $137.41 | 79% | above 0% of 19 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 | UnitedHealthcare — Optum Behavioral Health | $64.63 | $82.68 | 78% | not typically billed by physician assistants |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | UnitedHealthcare — Optum Behavioral Health | $99.08 | $138.62 | 71% | 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 Andrea James, PA-C performs these services, and they are kept out of the benchmark above.