Kelly Coleman, M.D.
Pediatrics Physician · Houston, TX 77070 · NPI 1629165238
109%of Medicare
BCBSTX pays Kelly Coleman, M.D. $104.90 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 pediatrics physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $104.90 | $96.33 | 109% | above 71% of 769 Houston pediatrics physicians |
| 99214Office visit, established patient, moderate complexity | $161.73 | $137.41 | 118% | above 95% of 766 Houston pediatrics physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $1,025.28 | $317.92 | 322% | not typically billed by pediatrics physicians |
| 72148MRI lumbar spine, without contrast | $204.86 | $192.38 | 106% | not typically billed by pediatrics physicians |
| 74177CT abdomen and pelvis, with contrast | $845.42 | $300.72 | 281% | not typically billed by pediatrics physicians |
| 77067Screening mammography, bilateral | $100.99 | $126.38 | 80% | not typically billed by pediatrics 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 Kelly Coleman, M.D. performs these services, and they are kept out of the benchmark above.