Mercy ROY, APRN
Adult Health Nurse Practitioner · Houston, TX 77030 · NPI 1558149476
134%of Medicare
BCBSTX pays Mercy ROY, APRN $129.07 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 adult health nurse practitioners |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $129.07 | $96.33 | 134% | above 78% of 154 Houston adult health nurse practitioners |
| 99214Office visit, established patient, moderate complexity | $189.08 | $137.41 | 138% | above 79% of 154 Houston adult health nurse practitioners |
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 adult health nurse practitioners |
| 72148MRI lumbar spine, without contrast | $101.41 | $192.38 | 53% | not typically billed by adult health nurse practitioners |
| 74177CT abdomen and pelvis, with contrast | $125.18 | $300.72 | 42% | not typically billed by adult health nurse practitioners |
| 77067Screening mammography, bilateral | $186.80 | $126.38 | 148% | not typically billed by adult health nurse practitioners |
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 Mercy ROY, APRN performs these services, and they are kept out of the benchmark above.