Tahira Scholle, M.D.
Ophthalmology Physician · Houston, TX 77026 · NPI 1669792131
58%of Medicare
BCBSTX pays Tahira Scholle, M.D. $55.78 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 ophthalmology physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $55.78 | $96.33 | 58% | above 73% of 180 Houston ophthalmology physicians |
| 99214Office visit, established patient, moderate complexity | $130.73 | $137.41 | 95% | above 89% of 180 Houston ophthalmology physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $105.85 | $317.92 | 33% | not typically billed by ophthalmology physicians |
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by ophthalmology 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 Tahira Scholle, M.D. performs these services, and they are kept out of the benchmark above.