Scott Scheinin, MD
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician · Houston, TX 77030 · NPI 1619977238 · 1 payer file
80%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Scott Scheinin, MD $76.82 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 46 contract rows for this clinician and code, from $39.89 to $390.67; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston thoracic surgery (cardiothoracic vascular surgery) physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $76.82median of 46 rows · $39.89–$390.67 | $96.33 | 80% | above 19% of 103 Houston thoracic surgery (cardiothoracic vascular surgery) physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $110.90median of 46 rows · $54.00–$545.00 | $137.41 | 81% | above 18% of 103 Houston thoracic surgery (cardiothoracic vascular surgery) physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston thoracic surgery (cardiothoracic vascular surgery) physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $135.84median of 24 rows · $70.26–$290.42 | $82.68 | 164% | not typically billed by thoracic surgery (cardiothoracic vascular surgery) physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $254.70median of 24 rows · $118.81–$478.99 | $138.62 | 184% | not typically billed by thoracic surgery (cardiothoracic vascular surgery) 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 Scott Scheinin, MD performs these services, and they are kept out of the benchmark above.