Marceline Vilmont, LCSW
Social Worker · Houston, TX 77030 · NPI 1467163287 · 1 payer file
59%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Marceline Vilmont, LCSW $57.00 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 40 contract rows for this clinician and code, from $40.81 to $110.33; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston social workers, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $57.00median of 40 rows · $40.81–$110.33 | $96.33 | 59% | above 0% of 69 Houston social workers on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $88.74median of 50 rows · $63.11–$161.01 | $137.41 | 65% | above 1% of 69 Houston social workers on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston social workers, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $74.93median of 20 rows · $59.75–$99.91 | $82.68 | 91% | not typically billed by social workers |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $115.45median of 24 rows · $79.29–$166.92 | $138.62 | 83% | not typically billed by social workers |
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 Marceline Vilmont, LCSW performs these services, and they are kept out of the benchmark above.