Justin Moher, MD
Pediatric Emergency Medicine (Pediatrics) Physician · Houston, TX 77030 · NPI 1386089928 · 1 payer file
148%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Justin Moher, MD $142.63 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 42 contract rows for this clinician and code, from $72.15 to $192.06; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatric emergency medicine (pediatrics) physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $142.63median of 42 rows · $72.15–$192.06 | $96.33 | 148% | above 95% of 76 Houston pediatric emergency medicine (pediatrics) physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $202.59median of 56 rows · $86.95–$271.76 | $137.41 | 147% | above 95% of 76 Houston pediatric emergency medicine (pediatrics) physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatric emergency medicine (pediatrics) physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $117.01median of 18 rows · $103.24–$137.65 | $82.68 | 142% | not typically billed by pediatric emergency medicine (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 Justin Moher, MD performs these services, and they are kept out of the benchmark above.