Jeffery Whelan, MD
Sports Medicine (Orthopaedic Surgery) Physician · Houston, TX 77025 · NPI 1487740676
78%of Medicare
BCBSTX pays Jeffery Whelan, MD $75.38 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 sports medicine (orthopaedic surgery) physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $75.38 | $96.33 | 78% | above 66% of 33 Houston sports medicine (orthopaedic surgery) physicians |
| 99214Office visit, established patient, moderate complexity | $80.01 | $137.41 | 58% | above 0% of 33 Houston sports medicine (orthopaedic surgery) physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $294.89 | $317.92 | 93% | not typically billed by sports medicine (orthopaedic surgery) physicians |
| 72148MRI lumbar spine, without contrast | $176.75 | $192.38 | 92% | not typically billed by sports medicine (orthopaedic surgery) physicians |
| 74177CT abdomen and pelvis, with contrast | $78.35 | $300.72 | 26% | not typically billed by sports medicine (orthopaedic surgery) physicians |
| 77067Screening mammography, bilateral | $116.92 | $126.38 | 93% | not typically billed by sports medicine (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 Jeffery Whelan, MD performs these services, and they are kept out of the benchmark above.