Toby Bradley, MA, LCDC
Addiction (Substance Use Disorder) Counselor · Houston, TX 77074 · NPI 1720898406 · 1 payer file
72%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Toby Bradley, MA, LCDC $69.36 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 20 contract rows for this clinician and code, from $55.30 to $81.60; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston addiction (substance use disorder) counselors, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $69.36median of 20 rows · $55.30–$81.60 | $96.33 | 72% | above 25% of 25 Houston addiction (substance use disorder) counselors on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $100.61median of 20 rows · $81.21–$118.37 | $137.41 | 73% | above 33% of 25 Houston addiction (substance use disorder) counselors on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston addiction (substance use disorder) counselors, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $66.56median of 12 rows · $58.73–$78.30 | $82.68 | 81% | not typically billed by addiction (substance use disorder) counselors |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $115.61median of 12 rows · $102.01–$136.02 | $138.62 | 83% | not typically billed by addiction (substance use disorder) counselors |
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 Toby Bradley, MA, LCDC performs these services, and they are kept out of the benchmark above.