Summer Garcia
Mental Health Counselor · Houston, TX 77070 · NPI 1518843317 · 1 payer file
68%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Summer Garcia $65.46 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 60 contract rows for this clinician and code, from $52.15 to $83.23; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston mental health counselors, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $65.46median of 60 rows · $52.15–$83.23 | $96.33 | 68% | above 4% of 430 Houston mental health counselors on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $95.14median of 60 rows · $76.78–$120.73 | $137.41 | 69% | above 31% of 430 Houston mental health counselors on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston mental health counselors, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $66.62median of 24 rows · $57.67–$79.86 | $82.68 | 81% | not typically billed by mental health counselors |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $116.77median of 24 rows · $102.01–$138.74 | $138.62 | 84% | not typically billed by mental health counselors |
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 Summer Garcia performs these services, and they are kept out of the benchmark above.