Mustafa Arain, M.D.
Gastroenterology Physician · Houston, TX 77030 · NPI 1669420618 · 1 payer file
126%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Mustafa Arain, M.D. $120.97 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 88 contract rows for this clinician and code, from $45.23 to $224.57; 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) | $120.97median of 88 rows · $45.23–$224.57 | $96.33 | 126% | above 89% of 214 Houston gastroenterology physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $185.02median of 88 rows · $66.92–$331.60 | $137.41 | 135% | above 89% 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) | $83.80median of 32 rows · $65.68–$103.35 | $82.68 | 101% | not typically billed by gastroenterology physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $132.66median of 24 rows · $110.34–$165.02 | $138.62 | 96% | 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 Mustafa Arain, M.D. performs these services, and they are kept out of the benchmark above.