Serena DAY, MD
Plastic and Reconstructive Surgery Physician · Houston, TX 77030 · NPI 1578068433 · 1 payer file
64%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Serena DAY, MD $61.65 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. The file lists 24 contract rows for this clinician and code, from $45.23 to $84.00; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston plastic and reconstructive surgery physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $61.65median of 24 rows · $45.23–$84.00 | $96.33 | 64% | above 2% of 66 Houston plastic and reconstructive surgery physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $89.16median of 24 rows · $66.92–$118.77 | $137.41 | 65% | above 2% of 66 Houston plastic and reconstructive surgery physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston plastic and reconstructive surgery physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $79.09median of 24 rows · $65.68–$98.52 | $82.68 | 96% | not typically billed by plastic and reconstructive surgery physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $132.66median of 24 rows · $110.34–$165.02 | $138.62 | 96% | not typically billed by plastic and reconstructive surgery 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 Serena DAY, MD performs these services, and they are kept out of the benchmark above.