Sapna Mehta, M.D.
Infectious Disease Physician · Houston, TX 77030 · NPI 1487866406 · 1 payer file
130%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Sapna Mehta, M.D. $124.82 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 62 contract rows for this clinician and code, from $39.90 to $197.95; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston infectious disease physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $124.82median of 62 rows · $39.90–$197.95 | $96.33 | 130% | above 80% of 116 Houston infectious disease physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $164.25median of 86 rows · $54.00–$285.72 | $137.41 | 120% | above 77% of 116 Houston infectious disease physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston infectious disease physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $165.26median of 42 rows · $70.26–$205.15 | $82.68 | 200% | not typically billed by infectious disease physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $274.60median of 42 rows · $118.82–$346.93 | $138.62 | 198% | not typically billed by infectious disease 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 Sapna Mehta, M.D. performs these services, and they are kept out of the benchmark above.