Jean Lafontaine Rivera, MD
Pediatrics Physician · Houston, TX 77030 · NPI 1326527219 · 1 payer file
70%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Jean Lafontaine Rivera, MD $67.34 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 24 contract rows for this clinician and code, from $62.85 to $84.18; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatrics physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $67.34median of 24 rows · $62.85–$84.18 | $96.33 | 70% | above 2% of 715 Houston pediatrics physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $97.36median of 24 rows · $89.81–$119.74 | $137.41 | 71% | above 2% of 717 Houston pediatrics physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatrics physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $58.38median of 12 rows · $51.51–$68.68 | $82.68 | 71% | not typically billed by pediatrics physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $104.71median of 12 rows · $92.39–$123.19 | $138.62 | 76% | not typically billed by pediatrics 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 Jean Lafontaine Rivera, MD performs these services, and they are kept out of the benchmark above.