Andres Tapia, LPC
Clinical Psychologist · Houston, TX 77057 · NPI 1699071852 · 3 payer files
56%of Medicare
Cigna — Texas Connect (individual & family) pays Andres Tapia, LPC $53.79 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 2 contract rows for this clinician and code, from $53.79 to $53.79; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston clinical psychologists, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Texas Connect (individual & family) | $53.79median of 2 rows · $53.79–$53.79 | $96.33 | 56% | above 11% of 73 Houston clinical psychologists on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $65.46median of 60 rows · $52.15–$81.60 | $96.33 | 68% | above 21% of 169 Houston clinical psychologists on this plan | |
| 99214Office visit, established patient, moderate complexity | Cigna — Texas Connect (individual & family) | $84.39median of 2 rows · $84.39–$84.39 | $137.41 | 61% | above 11% of 73 Houston clinical psychologists on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $95.14median of 60 rows · $76.78–$118.37 | $137.41 | 69% | above 27% of 170 Houston clinical psychologists on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston clinical psychologists, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Texas Connect (individual & family) | $28.00median of 2 rows · $28.00–$28.00 | $82.68 | 34% | not typically billed by clinical psychologists |
| UnitedHealthcare — Optum Behavioral Health | $64.63 | $82.68 | 78% | not typically billed by clinical psychologists | |
| Aetna — Texas (office visit and psychotherapy codes only) | $65.96median of 24 rows · $57.67–$78.30 | $82.68 | 80% | not typically billed by clinical psychologists | |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Texas Connect (individual & family) | $75.00median of 2 rows · $75.00–$75.00 | $138.62 | 54% | not typically billed by clinical psychologists |
| UnitedHealthcare — Optum Behavioral Health | $116.57 | $138.62 | 84% | not typically billed by clinical psychologists | |
| Aetna — Texas (office visit and psychotherapy codes only) | $115.61median of 18 rows · $102.01–$136.02 | $138.62 | 83% | not typically billed by clinical 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 Andres Tapia, LPC performs these services, and they are kept out of the benchmark above.