Monica Grover, MD
Child & Adolescent Psychiatry Physician · Houston, TX 77019 · NPI 1386991073
82%of Medicare
BCBSTX pays Monica Grover, MD $78.91 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.
Negotiated rates vs Medicare
| Service | BCBSTX | Medicare | % of Medicare | Among Houston child & adolescent psychiatry physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $78.91 | $96.33 | 82% | above 13% of 63 Houston child & adolescent psychiatry physicians |
| 99214Office visit, established patient, moderate complexity | $115.60 | $137.41 | 84% | above 16% of 63 Houston child & adolescent psychiatry physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $251.39 | $317.92 | 79% | not typically billed by child & adolescent psychiatry physicians |
| 72148MRI lumbar spine, without contrast | $54.11 | $192.38 | 28% | not typically billed by child & adolescent psychiatry 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 Monica Grover, MD performs these services, and they are kept out of the benchmark above.