Justin Lebenthal
Medical Oncology Physician · Houston, TX 77030 · NPI 1255836052 · 1 payer file
154%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Justin Lebenthal $148.46 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 42 contract rows for this clinician and code, from $87.38 to $197.95; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston medical oncology physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $148.46median of 42 rows · $87.38–$197.95 | $96.33 | 154% | above 22% of 154 Houston medical oncology physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $214.29median of 56 rows · $118.25–$285.72 | $137.41 | 156% | above 22% of 154 Houston medical oncology physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston medical oncology physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $172.05median of 30 rows · $153.86–$205.15 | $82.68 | 208% | not typically billed by medical oncology physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $286.24median of 30 rows · $260.21–$346.93 | $138.62 | 206% | not typically billed by medical oncology 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 Justin Lebenthal performs these services, and they are kept out of the benchmark above.