Cornelius Wilson, M.D.
Adolescent Medicine (Internal Medicine) Physician · Houston, TX 77015 · NPI 1215032586
60%of Medicare
BCBSTX pays Cornelius Wilson, M.D. $57.73 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 | BCBSTX | Medicare | % of Medicare | Among Houston adolescent medicine (internal medicine) physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $57.73 | $96.33 | 60% | above 54% of 24,819 all Houston clinicians |
| 99214Office visit, established patient, moderate complexity | $88.98 | $137.41 | 65% | above 51% of 24,759 all Houston clinicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $88.84 | $317.92 | 28% | not typically billed by adolescent medicine (internal medicine) physicians |
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by adolescent medicine (internal medicine) physicians |
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by adolescent medicine (internal medicine) physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by adolescent medicine (internal medicine) 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 Cornelius Wilson, M.D. performs these services, and they are kept out of the benchmark above.