Rosemary Elder
Community Health Worker · Houston, TX 77067 · NPI 1639036361 · 1 payer file
72%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Rosemary Elder $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 20 contract rows for this clinician and code, from $55.29 to $81.59; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston community health workers, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $69.35median of 20 rows · $55.29–$81.59 | $96.33 | 72% | above 20% of 21,862 all Houston clinicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $100.60median of 20 rows · $81.20–$118.37 | $137.41 | 73% | above 23% of 21,418 all Houston clinicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston community health workers, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $66.56median of 12 rows · $58.72–$78.29 | $82.68 | 81% | not typically billed by community health workers |
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 Rosemary Elder performs these services, and they are kept out of the benchmark above.