Mary Lamb, BCBA
Behavior Analyst · Houston, TX 77092 · NPI 1558693317 · 1 payer file
85%of Medicare
UnitedHealthcare — Optum Behavioral Health pays Mary Lamb, BCBA $81.58 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 | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston behavior analysts, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | UnitedHealthcare — Optum Behavioral Health | $81.58 | $96.33 | 85% | above 25% of 718 all Houston clinicians on this plan |
| 99214Office visit, established patient, moderate complexity | UnitedHealthcare — Optum Behavioral Health | $120.38 | $137.41 | 88% | above 65% of 711 all Houston clinicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston behavior analysts, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | UnitedHealthcare — Optum Behavioral Health | $76.03 | $82.68 | 92% | not typically billed by behavior analysts |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | UnitedHealthcare — Optum Behavioral Health | $126.72 | $138.62 | 91% | not typically billed by behavior analysts |
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 Lamb, BCBA performs these services, and they are kept out of the benchmark above.