Thomas Guillot, M.D.
Specialist · Houston, TX 77089 · NPI 1336147925 · 1 payer file
64%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Thomas Guillot, M.D. $61.43 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 26 contract rows for this clinician and code, from $49.77 to $72.26; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston specialists, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $61.43median of 26 rows · $49.77–$72.26 | $96.33 | 64% | above 2% of 61 Houston specialists on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $90.89median of 24 rows · $76.41–$106.92 | $137.41 | 66% | above 2% of 61 Houston specialists on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston specialists, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $60.72median of 18 rows · $53.58–$71.44 | $82.68 | 73% | not typically billed by specialists |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $100.91median of 12 rows · $89.04–$118.72 | $138.62 | 73% | not typically billed by specialists |
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 Guillot, M.D. performs these services, and they are kept out of the benchmark above.