Kyle Blum, MD, MS
Student in an Organized Health Care Education/Training Program · Houston, TX 77030 · NPI 1285193516 · 1 payer file
225%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Kyle Blum, MD, MS $216.37 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 8 contract rows for this clinician and code, from $176.98 to $255.75; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston student in an organized health care education/training programs, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $216.37median of 8 rows · $176.98–$255.75 | $96.33 | 225% | above 96% of 97 Houston student in an organized health care education/training programs on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $323.38median of 8 rows · $270.43–$376.32 | $137.41 | 235% | above 99% of 94 Houston student in an organized health care education/training programs on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston student in an organized health care education/training programs, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $225.73median of 8 rows · $221.22–$230.24 | $82.68 | 273% | not typically billed by student in an organized health care education/training programs |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $375.71median of 8 rows · $367.96–$383.46 | $138.62 | 271% | not typically billed by student in an organized health care education/training programs |
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 Kyle Blum, MD, MS performs these services, and they are kept out of the benchmark above.