Mary Hughes, RN, CNS
Clinical Nurse Specialist · Houston, TX 77030 · NPI 1518047265
46%of Medicare
BCBSTX pays Mary Hughes, RN, CNS $44.19 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 clinical nurse specialists |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $44.19 | $96.33 | 46% | above 22% of 24,819 all Houston clinicians |
| 99214Office visit, established patient, moderate complexity | $94.00 | $137.41 | 68% | above 53% of 24,759 all Houston clinicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $157.20 | $317.92 | 49% | not typically billed by clinical nurse specialists |
| 72148MRI lumbar spine, without contrast | $101.41 | $192.38 | 53% | not typically billed by clinical nurse specialists |
| 74177CT abdomen and pelvis, with contrast | $60.13 | $300.72 | 20% | not typically billed by clinical nurse specialists |
| 77067Screening mammography, bilateral | $25.17 | $126.38 | 20% | not typically billed by 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 Mary Hughes, RN, CNS performs these services, and they are kept out of the benchmark above.