Natalie Wald, APRN, AGCNS-BC
Gerontology Clinical Nurse Specialist · Houston, TX 77056 · NPI 1497271084
71%of Medicare
BCBSTX pays Natalie Wald, APRN, AGCNS-BC $68.45 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 gerontology clinical nurse specialists |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $68.45 | $96.33 | 71% | above 68% of 24,819 all Houston clinicians |
| 99214Office visit, established patient, moderate complexity | $68.00 | $137.41 | 49% | above 24% of 24,759 all Houston clinicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $83.64 | $317.92 | 26% | not typically billed by gerontology clinical nurse specialists |
| 72148MRI lumbar spine, without contrast | $50.75 | $192.38 | 26% | not typically billed by gerontology clinical nurse specialists |
| 74177CT abdomen and pelvis, with contrast | $223.17 | $300.72 | 74% | not typically billed by gerontology clinical nurse specialists |
| 77067Screening mammography, bilateral | $99.39 | $126.38 | 79% | not typically billed by gerontology clinical nurse specialists |
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 Natalie Wald, APRN, AGCNS-BC performs these services, and they are kept out of the benchmark above.