Adiaha Spinks-franklin, MD, MPH
Developmental - Behavioral Pediatrics Physician · Houston, TX 77030 · NPI 1346320785 · 1 payer file
111%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Adiaha Spinks-franklin, MD, MPH $106.96 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 20 contract rows for this clinician and code, from $79.00 to $125.84; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston developmental - behavioral pediatrics physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $106.96median of 20 rows · $79.00–$125.84 | $96.33 | 111% | above 36% of 15 Houston developmental - behavioral pediatrics physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $152.98median of 30 rows · $115.72–$183.95 | $137.41 | 111% | above 36% of 15 Houston developmental - behavioral pediatrics physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston developmental - behavioral pediatrics physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $99.40median of 12 rows · $87.71–$116.95 | $82.68 | 120% | not typically billed by developmental - behavioral 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 Adiaha Spinks-franklin, MD, MPH performs these services, and they are kept out of the benchmark above.