Brian Douglas, M.D.
Gastroenterology Physician · Houston, TX 77030 · NPI 1578540761 · 2 payer files
65%of Medicare
Cigna — Houston FlexCare pays Brian Douglas, M.D. $62.74 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 4 contract rows for this clinician and code, from $51.86 to $73.63; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston gastroenterology physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Houston FlexCare | $62.74median of 4 rows · $51.86–$73.63 | $96.33 | 65% | above 0% of 23 Houston gastroenterology physicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $86.89median of 8 rows · $65.91–$107.88 | $96.33 | 90% | above 34% of 214 Houston gastroenterology physicians on this plan | |
| 99214Office visit, established patient, moderate complexity | Cigna — Houston FlexCare | $94.06median of 4 rows · $79.42–$108.69 | $137.41 | 68% | above 0% of 23 Houston gastroenterology physicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $125.48median of 8 rows · $97.07–$153.89 | $137.41 | 91% | above 34% of 214 Houston gastroenterology physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston gastroenterology physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Houston FlexCare | $86.14median of 4 rows · $84.55–$87.74 | $82.68 | 104% | not typically billed by gastroenterology physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Houston FlexCare | $143.52median of 4 rows · $140.79–$146.25 | $138.62 | 104% | not typically billed by gastroenterology physicians |
| 70553MRI brain, with and without contrast | Cigna — Houston FlexCare | $331.87median of 2 rows · $331.87–$331.87 | $317.92 | 104% | not typically billed by gastroenterology physicians |
| 72148MRI lumbar spine, without contrast | Cigna — Houston FlexCare | $197.39median of 2 rows · $197.39–$197.39 | $192.38 | 103% | not typically billed by gastroenterology physicians |
| 74177CT abdomen and pelvis, with contrast | Cigna — Houston FlexCare | $273.32median of 2 rows · $273.32–$273.32 | $300.72 | 91% | not typically billed by gastroenterology physicians |
| 77067Screening mammography, bilateral | Cigna — Houston FlexCare | $120.84median of 2 rows · $120.84–$120.84 | $126.38 | 96% | not typically billed by gastroenterology 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 Brian Douglas, M.D. performs these services, and they are kept out of the benchmark above.