Matthew Pommerening, M.D.
Surgery Physician · Houston, TX 77030 · NPI 1245586650 · 1 payer file
126%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Matthew Pommerening, M.D. $121.56 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 16 contract rows for this clinician and code, from $99.71 to $143.41; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston surgery physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $121.56median of 16 rows · $99.71–$143.41 | $96.33 | 126% | above 75% of 230 Houston surgery physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $182.14median of 16 rows · $153.13–$211.16 | $137.41 | 133% | above 75% of 230 Houston surgery physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston surgery physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $127.44median of 16 rows · $126.73–$128.15 | $82.68 | 154% | not typically billed by surgery physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $213.87median of 16 rows · $213.16–$214.58 | $138.62 | 154% | not typically billed by 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 Matthew Pommerening, M.D. performs these services, and they are kept out of the benchmark above.