Sandra Hotz, PH.D.
Psychologist · Houston, TX 77024 · NPI 1649393562 · 3 payer files
65%of Medicare
Cigna — Houston FlexCare pays Sandra Hotz, PH.D. $62.74 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 4 contract rows for this clinician and code, from $51.86 to $73.63; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston psychologists, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Houston FlexCare | $62.74median of 4 rows · $51.86–$73.63 | $96.33 | 65% | above 3% of 858 all Houston clinicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $69.36median of 20 rows · $55.30–$81.60 | $96.33 | 72% | above 45% of 120 Houston psychologists on this plan | |
| 99214Office visit, established patient, moderate complexity | Cigna — Houston FlexCare | $94.06median of 4 rows · $79.42–$108.69 | $137.41 | 68% | above 3% of 858 all Houston clinicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $100.61median of 20 rows · $81.21–$118.37 | $137.41 | 73% | above 55% of 120 Houston psychologists on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston psychologists, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Houston FlexCare | $86.14median of 4 rows · $84.55–$87.74 | $82.68 | 104% | not typically billed by psychologists |
| UnitedHealthcare — Optum Behavioral Health | $64.63 | $82.68 | 78% | not typically billed by psychologists | |
| Aetna — Texas (office visit and psychotherapy codes only) | $66.56median of 12 rows · $58.73–$78.30 | $82.68 | 81% | not typically billed by psychologists | |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Houston FlexCare | $143.52median of 4 rows · $140.79–$146.25 | $138.62 | 104% | not typically billed by psychologists |
| UnitedHealthcare — Optum Behavioral Health | $116.57 | $138.62 | 84% | not typically billed by psychologists | |
| Aetna — Texas (office visit and psychotherapy codes only) | $115.61median of 12 rows · $102.01–$136.02 | $138.62 | 83% | not typically billed by psychologists | |
| 70553MRI brain, with and without contrast | Cigna — Houston FlexCare | $331.87median of 2 rows · $331.87–$331.87 | $317.92 | 104% | not typically billed by psychologists |
| 72148MRI lumbar spine, without contrast | Cigna — Houston FlexCare | $197.39median of 2 rows · $197.39–$197.39 | $192.38 | 103% | not typically billed by psychologists |
| 74177CT abdomen and pelvis, with contrast | Cigna — Houston FlexCare | $273.32median of 2 rows · $273.32–$273.32 | $300.72 | 91% | not typically billed by psychologists |
| 77067Screening mammography, bilateral | Cigna — Houston FlexCare | $120.84median of 2 rows · $120.84–$120.84 | $126.38 | 96% | not typically billed by psychologists |
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 Sandra Hotz, PH.D. performs these services, and they are kept out of the benchmark above.