Domonique James
Multi-Specialty Clinic/Center · Houston, TX 77063 · NPI 1336006527 · 1 payer file
74%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Domonique James $71.58 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 44 contract rows for this clinician and code, from $50.20 to $95.45; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston multi-specialty clinic/centers, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $71.58median of 44 rows · $50.20–$95.45 | $96.33 | 74% | above 41% of 21,862 all Houston clinicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $103.56median of 88 rows · $73.73–$138.08 | $137.41 | 75% | above 48% of 21,418 all Houston clinicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston multi-specialty clinic/centers, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $65.18median of 36 rows · $48.89–$90.03 | $82.68 | 79% | not typically billed by multi-specialty clinic/centers |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $108.85median of 72 rows · $81.65–$149.90 | $138.62 | 79% | not typically billed by multi-specialty clinic/centers |
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 Domonique James performs these services, and they are kept out of the benchmark above.