Beth Pineles, M.D.,PH.D.
Maternal & Fetal Medicine Physician · Houston, TX 77030 · NPI 1578957767 · 1 payer file
96%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Beth Pineles, M.D.,PH.D. $92.12 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 96 contract rows for this clinician and code, from $37.95 to $150.03; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston maternal & fetal medicine physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $92.12median of 96 rows · $37.95–$150.03 | $96.33 | 96% | above 21% of 88 Houston maternal & fetal medicine physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $151.00median of 76 rows · $56.07–$215.00 | $137.41 | 110% | above 51% of 88 Houston maternal & fetal medicine physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston maternal & fetal medicine physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $192.96median of 12 rows · $170.27–$227.02 | $82.68 | 233% | not typically billed by maternal & fetal medicine physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $322.09median of 12 rows · $284.19–$378.94 | $138.62 | 232% | not typically billed by maternal & fetal 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 Beth Pineles, M.D.,PH.D. performs these services, and they are kept out of the benchmark above.