Lori Blankenship, FNP-BC
Family Nurse Practitioner · Houston, TX 77070 · NPI 1215268404 · 2 payer files
76%of Medicare
UnitedHealthcare — Optum Behavioral Health pays Lori Blankenship, FNP-BC $73.34 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 family nurse practitioners, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | UnitedHealthcare — Optum Behavioral Health | $73.34 | $96.33 | 76% | above 0% of 15 Houston family nurse practitioners on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $46.86median of 72 rows · $29.51–$77.90 | $96.33 | 49% | above 0% of 1,439 Houston family nurse practitioners on this plan | |
| 99214Office visit, established patient, moderate complexity | UnitedHealthcare — Optum Behavioral Health | $103.71 | $137.41 | 75% | above 0% of 15 Houston family nurse practitioners on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $67.75median of 72 rows · $43.59–$110.29 | $137.41 | 49% | above 0% of 1,443 Houston family nurse practitioners on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston family nurse practitioners, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | UnitedHealthcare — Optum Behavioral Health | $61.40 | $82.68 | 74% | not typically billed by family nurse practitioners |
| Aetna — Texas (office visit and psychotherapy codes only) | $55.85median of 48 rows · $46.54–$69.44 | $82.68 | 68% | not typically billed by family nurse practitioners | |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | UnitedHealthcare — Optum Behavioral Health | $94.13 | $138.62 | 68% | not typically billed by family nurse practitioners |
| Aetna — Texas (office visit and psychotherapy codes only) | $93.83median of 48 rows · $78.31–$116.49 | $138.62 | 68% | not typically billed by family 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 Lori Blankenship, FNP-BC performs these services, and they are kept out of the benchmark above.