Daniela Paul
Social Worker · Houston, TX 77090 · NPI 1326777061 · 1 payer file
76%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Daniela Paul $73.40 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 192 contract rows for this clinician and code, from $51.64 to $88.83; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston social workers, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $73.40median of 192 rows · $51.64–$88.83 | $96.33 | 76% | above 93% of 69 Houston social workers on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $104.98median of 172 rows · $75.64–$129.84 | $137.41 | 76% | above 94% of 69 Houston social workers on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston social workers, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $68.21median of 114 rows · $57.33–$82.55 | $82.68 | 82% | not typically billed by social workers |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $113.87median of 72 rows · $95.69–$137.79 | $138.62 | 82% | not typically billed by social workers |
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 Daniela Paul performs these services, and they are kept out of the benchmark above.