Kathy Luong, MSN, RN, CPNP-AC
Pediatric Nurse Practitioner · Houston, TX 77030 · NPI 1629581657
121%of Medicare
BCBSTX pays Kathy Luong, MSN, RN, CPNP-AC $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 pediatric nurse practitioners |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $116.53 | $96.33 | 121% | above 96% of 234 Houston pediatric nurse practitioners |
| 99214Office visit, established patient, moderate complexity | $123.69 | $137.41 | 90% | above 97% of 233 Houston pediatric nurse practitioners |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by pediatric nurse practitioners |
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 Kathy Luong, MSN, RN, CPNP-AC performs these services, and they are kept out of the benchmark above.