Scott Whittaker, H.B.SC KIN, DPT
Physical Therapist · Houston, TX 77074 · NPI 1710251558 · 1 payer file
69%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Scott Whittaker, H.B.SC KIN, DPT $65.99 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 52 contract rows for this clinician and code, from $49.33 to $77.63; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston physical therapists, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $65.99median of 52 rows · $49.33–$77.63 | $96.33 | 69% | above 38% of 104 Houston physical therapists on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $94.56median of 48 rows · $72.50–$114.14 | $137.41 | 69% | above 31% of 106 Houston physical therapists on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston physical therapists, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $75.86median of 12 rows · $66.94–$89.25 | $82.68 | 92% | not typically billed by physical therapists |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $128.30median of 12 rows · $113.21–$150.94 | $138.62 | 93% | not typically billed by physical therapists |
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 Scott Whittaker, H.B.SC KIN, DPT performs these services, and they are kept out of the benchmark above.