Matthew Higgs, M.D.
Sports Medicine (Family Medicine) Physician · Houston, TX 77058 · NPI 1588828800
54%of Medicare
BCBSTX pays Matthew Higgs, M.D. $51.98 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 sports medicine (family medicine) physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $51.98 | $96.33 | 54% | above 5% of 23 Houston sports medicine (family medicine) physicians |
| 99214Office visit, established patient, moderate complexity | $80.13 | $137.41 | 58% | above 0% of 23 Houston sports medicine (family medicine) physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $88.84 | $317.92 | 28% | not typically billed by sports medicine (family medicine) physicians |
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by sports medicine (family medicine) physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by sports 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 Matthew Higgs, M.D. performs these services, and they are kept out of the benchmark above.