Michael Fallon, MD
Gastroenterology Physician · Houston, TX 77030 · NPI 1629163613 · 1 payer file
64%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Michael Fallon, MD $61.52 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 64 contract rows for this clinician and code, from $41.43 to $206.01; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston gastroenterology physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $61.52median of 64 rows · $41.43–$206.01 | $96.33 | 64% | above 1% of 214 Houston gastroenterology physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $100.13median of 40 rows · $61.00–$290.72 | $137.41 | 73% | above 4% of 214 Houston gastroenterology physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston gastroenterology physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $61.92median of 32 rows · $47.41–$140.83 | $82.68 | 75% | not typically billed by gastroenterology physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $104.75median of 64 rows · $80.42–$275.12 | $138.62 | 76% | not typically billed by gastroenterology 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 Michael Fallon, MD performs these services, and they are kept out of the benchmark above.