Thomas Shields, DPM
Primary Podiatric Medicine Podiatrist · Houston, TX 77002 · NPI 1306955471 · 1 payer file
78%of Medicare
Cigna — Texas Connect (individual & family) pays Thomas Shields, DPM $75.21 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 2 contract rows for this clinician and code, from $62.82 to $87.60; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston primary podiatric medicine podiatrists, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Texas Connect (individual & family) | $75.21median of 2 rows · $62.82–$87.60 | $96.33 | 78% | above 56% of 1,164 all Houston clinicians on this plan |
| 99214Office visit, established patient, moderate complexity | Cigna — Texas Connect (individual & family) | $108.11median of 2 rows · $92.66–$123.56 | $137.41 | 79% | above 55% of 1,164 all Houston clinicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston primary podiatric medicine podiatrists, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Texas Connect (individual & family) | $71.71median of 2 rows · $67.48–$75.93 | $82.68 | 87% | not typically billed by primary podiatric medicine podiatrists |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Texas Connect (individual & family) | $120.24median of 2 rows · $113.20–$127.28 | $138.62 | 87% | not typically billed by primary podiatric medicine podiatrists |
| 70553MRI brain, with and without contrast | Cigna — Texas Connect (individual & family) | $309.10 | $317.92 | 97% | not typically billed by primary podiatric medicine podiatrists |
| 72148MRI lumbar spine, without contrast | Cigna — Texas Connect (individual & family) | $185.68 | $192.38 | 97% | not typically billed by primary podiatric medicine podiatrists |
| 74177CT abdomen and pelvis, with contrast | Cigna — Texas Connect (individual & family) | $294.08 | $300.72 | 98% | not typically billed by primary podiatric medicine podiatrists |
| 77067Screening mammography, bilateral | Cigna — Texas Connect (individual & family) | $113.17 | $126.38 | 90% | not typically billed by primary podiatric medicine podiatrists |
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 Thomas Shields, DPM performs these services, and they are kept out of the benchmark above.