Sanjay Adhia, MD
Forensic Psychiatry Physician · Houston, TX 77030 · NPI 1467658930
95%of Medicare
BCBSTX pays Sanjay Adhia, MD $91.45 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 forensic psychiatry physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $91.45 | $96.33 | 95% | above 73% of 24,819 all Houston clinicians |
| 99214Office visit, established patient, moderate complexity | $133.97 | $137.41 | 97% | above 80% of 24,759 all Houston clinicians |
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 forensic psychiatry physicians |
| 72148MRI lumbar spine, without contrast | $54.11 | $192.38 | 28% | not typically billed by forensic 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 Sanjay Adhia, MD performs these services, and they are kept out of the benchmark above.