Delma Montoya Monge, MD
Geriatric Medicine (Family Medicine) Physician · Houston, TX 77028 · NPI 1558851246
95%of Medicare
BCBSTX pays Delma Montoya Monge, MD $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 geriatric medicine (family medicine) physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $91.45 | $96.33 | 95% | above 89% of 20 Houston geriatric medicine (family medicine) physicians |
| 99214Office visit, established patient, moderate complexity | $133.97 | $137.41 | 97% | above 95% of 20 Houston geriatric medicine (family medicine) physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by geriatric medicine (family medicine) 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 Delma Montoya Monge, MD performs these services, and they are kept out of the benchmark above.