Lisette Zermeno, CNM
Advanced Practice Midwife · Houston, TX 77030 · NPI 1316103047
46%of Medicare
BCBSTX pays Lisette Zermeno, CNM $44.19 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.
Negotiated rates vs Medicare
| Service | BCBSTX | Medicare | % of Medicare | Among Houston advanced practice midwifes |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $44.19 | $96.33 | 46% | above 3% of 40 Houston advanced practice midwifes |
| 99214Office visit, established patient, moderate complexity | $73.09 | $137.41 | 53% | above 5% of 40 Houston advanced practice midwifes |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 77067Screening mammography, bilateral | $25.17 | $126.38 | 20% | not typically billed by advanced practice midwifes |
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 Lisette Zermeno, CNM performs these services, and they are kept out of the benchmark above.