Vinay Vanodia, M.D.
Physical Medicine & Rehabilitation Physician · Houston, TX 77030 · NPI 1538554084
95%of Medicare
BCBSTX pays Vinay Vanodia, M.D. $91.45 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 physical medicine & rehabilitation physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $91.45 | $96.33 | 95% | above 70% of 100 Houston physical medicine & rehabilitation physicians |
| 99214Office visit, established patient, moderate complexity | $133.97 | $137.41 | 97% | above 71% of 100 Houston physical medicine & rehabilitation physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $88.84 | $317.92 | 28% | not typically billed by physical medicine & rehabilitation physicians |
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by physical medicine & rehabilitation physicians |
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by physical medicine & rehabilitation physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by physical medicine & rehabilitation 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 Vinay Vanodia, M.D. performs these services, and they are kept out of the benchmark above.