Shannon Dicarlo, M.D.
Neurology with Special Qualifications in Child Neurology Physician · Houston, TX 77030 · NPI 1588968119
121%of Medicare
BCBSTX pays Shannon Dicarlo, M.D. $116.53 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 neurology with special qualifications in child neurology physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $116.53 | $96.33 | 121% | above 34% of 45 Houston neurology with special qualifications in child neurology physicians |
| 99214Office visit, established patient, moderate complexity | $123.69 | $137.41 | 90% | above 7% of 45 Houston neurology with special qualifications in child neurology 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 neurology with special qualifications in child neurology physicians |
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by neurology with special qualifications in child neurology physicians |
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by neurology with special qualifications in child neurology physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by neurology with special qualifications in child neurology 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 Shannon Dicarlo, M.D. performs these services, and they are kept out of the benchmark above.