Simone Hills, APRN, AGNP-C
Nurse Practitioner · Houston, TX 77070 · NPI 1730540881 · 1 payer file
59%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Simone Hills, APRN, AGNP-C $57.17 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 30 contract rows for this clinician and code, from $40.87 to $75.87; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston nurse practitioners, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $57.17median of 30 rows · $40.87–$75.87 | $96.33 | 59% | above 1% of 462 Houston nurse practitioners on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $84.43median of 40 rows · $62.51–$112.03 | $137.41 | 61% | above 2% of 458 Houston nurse practitioners on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston nurse practitioners, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $60.78median of 12 rows · $56.65–$71.50 | $82.68 | 74% | not typically billed by nurse practitioners |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $101.21median of 12 rows · $89.30–$119.07 | $138.62 | 73% | not typically billed by nurse practitioners |
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 Simone Hills, APRN, AGNP-C performs these services, and they are kept out of the benchmark above.