Gabriela Pequeno, LPC
Professional Counselor · Houston, TX 77074 · NPI 1376147934 · 2 payer files
87%of Medicare
UnitedHealthcare — Optum Behavioral Health pays Gabriela Pequeno, LPC $84.06 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 2 contract rows for this clinician and code, from $84.06 to $84.06; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston professional counselors, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | UnitedHealthcare — Optum Behavioral Health | $84.06median of 2 rows · $84.06–$84.06 | $96.33 | 87% | above 0% of 132 Houston professional counselors on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $72.25median of 90 rows · $53.11–$109.93 | $96.33 | 75% | above 49% of 1,205 Houston professional counselors on this plan | |
| 99214Office visit, established patient, moderate complexity | UnitedHealthcare — Optum Behavioral Health | $118.50median of 2 rows · $118.50–$118.50 | $137.41 | 86% | above 0% of 132 Houston professional counselors on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $94.84median of 80 rows · $76.90–$159.65 | $137.41 | 69% | above 7% of 1,207 Houston professional counselors on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston professional counselors, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | UnitedHealthcare — Optum Behavioral Health | $65.10median of 2 rows · $65.10–$65.10 | $82.68 | 79% | not typically billed by professional counselors |
| Aetna — Texas (office visit and psychotherapy codes only) | $75.03median of 60 rows · $55.28–$105.60 | $82.68 | 91% | not typically billed by professional counselors | |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | UnitedHealthcare — Optum Behavioral Health | $108.08median of 2 rows · $108.08–$108.08 | $138.62 | 78% | not typically billed by professional counselors |
| Aetna — Texas (office visit and psychotherapy codes only) | $122.70median of 56 rows · $92.58–$185.26 | $138.62 | 89% | not typically billed by professional counselors |
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 Gabriela Pequeno, LPC performs these services, and they are kept out of the benchmark above.