Leah Folb, M.D.
Endocrinology, Diabetes & Metabolism Physician · Houston, TX 77005 · NPI 1457517385 · 1 payer file
92%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Leah Folb, M.D. $88.50 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 16 contract rows for this clinician and code, from $72.79 to $120.73; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston endocrinology, diabetes & metabolism physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $88.50median of 16 rows · $72.79–$120.73 | $96.33 | 92% | above 30% of 108 Houston endocrinology, diabetes & metabolism physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $131.09median of 16 rows · $111.22–$172.24 | $137.41 | 95% | above 28% of 108 Houston endocrinology, diabetes & metabolism physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston endocrinology, diabetes & metabolism physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $98.02median of 8 rows · $88.64–$107.39 | $82.68 | 119% | not typically billed by endocrinology, diabetes & metabolism physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $164.16median of 8 rows · $148.41–$179.92 | $138.62 | 118% | not typically billed by endocrinology, diabetes & metabolism 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 Leah Folb, M.D. performs these services, and they are kept out of the benchmark above.