Muhammed Nathani, MD
Gastroenterology Physician · Houston, TX 77014 · NPI 1497745145
109%of Medicare
BCBSTX pays Muhammed Nathani, MD $104.90 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 gastroenterology physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $104.90 | $96.33 | 109% | above 86% of 219 Houston gastroenterology physicians |
| 99214Office visit, established patient, moderate complexity | $161.73 | $137.41 | 118% | above 91% of 219 Houston gastroenterology physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $1,025.28 | $317.92 | 322% | not typically billed by gastroenterology physicians |
| 72148MRI lumbar spine, without contrast | $204.86 | $192.38 | 106% | not typically billed by gastroenterology physicians |
| 74177CT abdomen and pelvis, with contrast | $845.42 | $300.72 | 281% | not typically billed by gastroenterology physicians |
| 77067Screening mammography, bilateral | $100.99 | $126.38 | 80% | not typically billed by gastroenterology 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 Muhammed Nathani, MD performs these services, and they are kept out of the benchmark above.