Thomas Macgillivray, MD
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician · Houston, TX 77030 · NPI 1184605354 · 1 payer file
150%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Thomas Macgillivray, MD $144.24 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 32 contract rows for this clinician and code, from $97.59 to $258.94; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston thoracic surgery (cardiothoracic vascular surgery) physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $144.24median of 32 rows · $97.59–$258.94 | $96.33 | 150% | above 91% of 103 Houston thoracic surgery (cardiothoracic vascular surgery) physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $212.00median of 32 rows · $150.25–$368.12 | $137.41 | 154% | above 90% of 103 Houston thoracic surgery (cardiothoracic vascular surgery) physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston thoracic surgery (cardiothoracic vascular surgery) physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $138.79median of 32 rows · $105.97–$215.71 | $82.68 | 168% | not typically billed by thoracic surgery (cardiothoracic vascular surgery) physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $233.45median of 32 rows · $178.57–$361.63 | $138.62 | 168% | not typically billed by thoracic surgery (cardiothoracic vascular 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 Thomas Macgillivray, MD performs these services, and they are kept out of the benchmark above.