John Heydemann, M.D.
Orthopaedic Surgery Physician · Houston, TX 77030 · NPI 1437400082
121%of Medicare
BCBSTX pays John Heydemann, M.D. $116.53 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 orthopaedic surgery physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $116.53 | $96.33 | 121% | above 93% of 119 Houston orthopaedic surgery physicians |
| 99214Office visit, established patient, moderate complexity | $123.69 | $137.41 | 90% | above 71% of 119 Houston orthopaedic surgery physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by orthopaedic surgery 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 John Heydemann, M.D. performs these services, and they are kept out of the benchmark above.