Afroz Shamim
Psychiatry Physician · Houston, TX 77030 · NPI 1497969323 · 3 payer files
115%of Medicare
Cigna — Houston FlexCare pays Afroz Shamim $110.38 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. The file lists 2 contract rows for this clinician and code, from $93.32 to $127.45; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston psychiatry physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Houston FlexCare | $110.38median of 2 rows · $93.32–$127.45 | $96.33 | 115% | above 79% of 858 all Houston clinicians on this plan |
| UnitedHealthcare — Optum Behavioral Health | $99.00median of 3 rows · $99.00–$99.00 | $96.33 | 103% | above 87% of 204 Houston psychiatry physicians on this plan | |
| Aetna — Texas (office visit and psychotherapy codes only) | $112.50median of 8 rows · $85.33–$139.67 | $96.33 | 117% | above 84% of 404 Houston psychiatry physicians on this plan | |
| 99214Office visit, established patient, moderate complexity | Cigna — Houston FlexCare | $158.43median of 2 rows · $137.04–$179.82 | $137.41 | 115% | above 79% of 858 all Houston clinicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $162.46median of 8 rows · $125.67–$199.24 | $137.41 | 118% | above 84% of 404 Houston psychiatry physicians on this plan | |
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Houston FlexCare | $93.53median of 2 rows · $88.24–$98.82 | $82.68 | 113% | above 79% of 858 all Houston clinicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $108.58median of 8 rows · $97.28–$119.88 | $82.68 | 131% | above 82% of 380 Houston psychiatry physicians on this plan | |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Houston FlexCare | $155.75median of 2 rows · $147.33–$164.16 | $138.62 | 112% | above 76% of 858 all Houston clinicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston psychiatry physicians, same plan |
|---|---|---|---|---|---|
| 70553MRI brain, with and without contrast | Cigna — Houston FlexCare | $480.63 | $317.92 | 151% | not typically billed by psychiatry physicians |
| 72148MRI lumbar spine, without contrast | Cigna — Houston FlexCare | $288.04 | $192.38 | 150% | not typically billed by psychiatry physicians |
| 74177CT abdomen and pelvis, with contrast | Cigna — Houston FlexCare | $462.54 | $300.72 | 154% | not typically billed by psychiatry physicians |
| 77067Screening mammography, bilateral | Cigna — Houston FlexCare | $115.80 | $126.38 | 92% | not typically billed by 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 Afroz Shamim performs these services, and they are kept out of the benchmark above.