Scott Carlson, MD
Endocrinology, Diabetes & Metabolism Physician · Houston, TX 77030 · NPI 1558899039
115%of Medicare
BCBSTX pays Scott Carlson, MD $111.04 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 endocrinology, diabetes & metabolism physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $111.04 | $96.33 | 115% | above 83% of 124 Houston endocrinology, diabetes & metabolism physicians |
| 99214Office visit, established patient, moderate complexity | $121.98 | $137.41 | 89% | above 65% of 124 Houston endocrinology, diabetes & metabolism physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $214.58 | $317.92 | 67% | not typically billed by endocrinology, diabetes & metabolism physicians |
| 74177CT abdomen and pelvis, with contrast | $161.40 | $300.72 | 54% | not typically billed by endocrinology, diabetes & metabolism 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 Scott Carlson, MD performs these services, and they are kept out of the benchmark above.