Winfred Tovar, M.D.
Critical Care Medicine (Anesthesiology) Physician · Houston, TX 77030 · NPI 1427230580
64%of Medicare
BCBSTX pays Winfred Tovar, M.D. $61.45 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 critical care medicine (anesthesiology) physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $61.45 | $96.33 | 64% | above 12% of 17 Houston critical care medicine (anesthesiology) physicians |
| 99214Office visit, established patient, moderate complexity | $80.13 | $137.41 | 58% | above 0% of 17 Houston critical care medicine (anesthesiology) physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by critical care medicine (anesthesiology) physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by critical care medicine (anesthesiology) 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 Winfred Tovar, M.D. performs these services, and they are kept out of the benchmark above.