Thomas Shaw, M.D.
Pediatric Anesthesiology Physician · Houston, TX 77030 · NPI 1235154386
168%of Medicare
BCBSTX pays Thomas Shaw, M.D. $161.52 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 pediatric anesthesiology physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $161.52 | $96.33 | 168% | above 27% of 49 Houston pediatric anesthesiology physicians |
| 99214Office visit, established patient, moderate complexity | $80.13 | $137.41 | 58% | above 2% of 49 Houston pediatric anesthesiology physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 72148MRI lumbar spine, without contrast | $426.00 | $192.38 | 221% | not typically billed by pediatric anesthesiology physicians |
| 74177CT abdomen and pelvis, with contrast | $426.00 | $300.72 | 142% | not typically billed by pediatric anesthesiology physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by pediatric anesthesiology 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 Shaw, M.D. performs these services, and they are kept out of the benchmark above.