Nehal Patel, MD
Nephrology Physician · Houston, TX 77008 · NPI 1285840462 · 2 payer files
87%of Medicare
Cigna — Houston FlexCare pays Nehal Patel, MD $84.10 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 4 contract rows for this clinician and code, from $68.49 to $99.72; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston nephrology physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Houston FlexCare | $84.10median of 4 rows · $68.49–$99.72 | $96.33 | 87% | above 22% of 41 Houston nephrology physicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $71.27median of 48 rows · $53.95–$126.47 | $96.33 | 74% | above 33% of 184 Houston nephrology physicians on this plan | |
| 99214Office visit, established patient, moderate complexity | Cigna — Houston FlexCare | $125.03median of 4 rows · $105.40–$144.67 | $137.41 | 91% | above 22% of 41 Houston nephrology physicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $104.76median of 38 rows · $79.48–$178.40 | $137.41 | 76% | above 35% of 184 Houston nephrology physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston nephrology physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Houston FlexCare | $91.44median of 4 rows · $87.18–$95.70 | $82.68 | 111% | not typically billed by nephrology physicians |
| Aetna — Texas (office visit and psychotherapy codes only) | $71.47median of 32 rows · $57.93–$100.17 | $82.68 | 86% | not typically billed by nephrology physicians | |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Houston FlexCare | $152.13median of 4 rows · $145.04–$159.23 | $138.62 | 110% | not typically billed by nephrology physicians |
| Aetna — Texas (office visit and psychotherapy codes only) | $115.60median of 18 rows · $102.01–$136.02 | $138.62 | 83% | not typically billed by nephrology physicians | |
| 70553MRI brain, with and without contrast | Cigna — Houston FlexCare | $347.07median of 2 rows · $347.07–$347.07 | $317.92 | 109% | not typically billed by nephrology physicians |
| 72148MRI lumbar spine, without contrast | Cigna — Houston FlexCare | $206.80median of 2 rows · $206.80–$206.80 | $192.38 | 107% | not typically billed by nephrology physicians |
| 74177CT abdomen and pelvis, with contrast | Cigna — Houston FlexCare | $311.22median of 2 rows · $311.22–$311.22 | $300.72 | 103% | not typically billed by nephrology physicians |
| 77067Screening mammography, bilateral | Cigna — Houston FlexCare | $130.39median of 2 rows · $130.39–$130.39 | $126.38 | 103% | not typically billed by nephrology 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 Nehal Patel, MD performs these services, and they are kept out of the benchmark above.