Lixin Zhang, M.D.
Hematology (Pathology) Physician · Houston, TX 77043 · NPI 1558520064
54%of Medicare
BCBSTX pays Lixin Zhang, M.D. $51.98 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 hematology (pathology) physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $51.98 | $96.33 | 54% | above 17% of 25 Houston hematology (pathology) physicians |
| 99214Office visit, established patient, moderate complexity | $80.13 | $137.41 | 58% | above 8% of 25 Houston hematology (pathology) physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $319.68 | $317.92 | 101% | not typically billed by hematology (pathology) physicians |
| 74177CT abdomen and pelvis, with contrast | $113.29 | $300.72 | 38% | not typically billed by hematology (pathology) physicians |
| 77067Screening mammography, bilateral | $47.42 | $126.38 | 38% | not typically billed by hematology (pathology) 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 Lixin Zhang, M.D. performs these services, and they are kept out of the benchmark above.