Joshua Bernstock, MD, PHD, MPH
Neurological Surgery Physician · Houston, TX 77030 · NPI 1184185829 · 1 payer file
111%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Joshua Bernstock, MD, PHD, MPH $106.62 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 28 contract rows for this clinician and code, from $60.93 to $142.16; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston neurological surgery physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $106.62median of 28 rows · $60.93–$142.16 | $96.33 | 111% | above 54% of 124 Houston neurological surgery physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $154.56median of 28 rows · $93.57–$206.08 | $137.41 | 112% | above 55% of 124 Houston neurological surgery physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston neurological surgery physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $115.25median of 12 rows · $101.70–$135.60 | $82.68 | 139% | not typically billed by neurological surgery physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $203.90median of 12 rows · $179.91–$239.89 | $138.62 | 147% | not typically billed by neurological surgery 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 Joshua Bernstock, MD, PHD, MPH performs these services, and they are kept out of the benchmark above.