Simon Kayyal, MD
Pediatrics Physician · Houston, TX 77030 · NPI 1700028735 · 1 payer file
66%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Simon Kayyal, MD $63.79 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 46 contract rows for this clinician and code, from $43.50 to $104.89; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatrics physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $63.79median of 46 rows · $43.50–$104.89 | $96.33 | 66% | above 1% of 715 Houston pediatrics physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $94.25median of 46 rows · $66.96–$148.88 | $137.41 | 69% | above 2% of 717 Houston pediatrics physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston pediatrics physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $72.25median of 40 rows · $64.00–$87.09 | $82.68 | 87% | not typically billed by pediatrics physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $130.36median of 12 rows · $114.75–$145.96 | $138.62 | 94% | not typically billed by pediatrics 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 Simon Kayyal, MD performs these services, and they are kept out of the benchmark above.