Paul Sykes, D.P.M.
Foot & Ankle Surgery Podiatrist · Houston, TX 77054 · NPI 1619934486 · 1 payer file
72%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Paul Sykes, D.P.M. $69.35 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 78 contract rows for this clinician and code, from $53.95 to $81.60; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston foot & ankle surgery podiatrists, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $69.35median of 78 rows · $53.95–$81.60 | $96.33 | 72% | above 38% of 48 Houston foot & ankle surgery podiatrists on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $100.60median of 80 rows · $79.48–$118.37 | $137.41 | 73% | above 36% of 48 Houston foot & ankle surgery podiatrists on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston foot & ankle surgery podiatrists, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $66.56median of 48 rows · $57.93–$78.30 | $82.68 | 81% | not typically billed by foot & ankle surgery podiatrists |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $115.60median of 30 rows · $102.01–$136.02 | $138.62 | 83% | not typically billed by foot & ankle surgery podiatrists |
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 Paul Sykes, D.P.M. performs these services, and they are kept out of the benchmark above.