YU LEI, DDS
Oral and Maxillofacial Pathology Dentistry · Houston, TX 77030 · NPI 1235501768 · 1 payer file
162%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays YU LEI, DDS $156.06 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 20 contract rows for this clinician and code, from $124.42 to $183.59; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston oral and maxillofacial pathology dentistrys, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $156.06median of 20 rows · $124.42–$183.59 | $96.33 | 162% | above 86% of 21,862 all Houston clinicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $226.37median of 20 rows · $182.72–$266.33 | $137.41 | 165% | above 87% of 21,418 all Houston clinicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston oral and maxillofacial pathology dentistrys, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $149.75median of 12 rows · $132.14–$176.17 | $82.68 | 181% | not typically billed by oral and maxillofacial pathology dentistrys |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $260.12median of 12 rows · $229.52–$306.04 | $138.62 | 188% | not typically billed by oral and maxillofacial pathology dentistrys |
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 YU LEI, DDS performs these services, and they are kept out of the benchmark above.