Luke Grome
Plastic Surgery Physician · Houston, TX 77030 · NPI 1730610064
115%of Medicare
BCBSTX pays Luke Grome $111.04 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.
Negotiated rates vs Medicare
| Service | BCBSTX | Medicare | % of Medicare | Among Houston plastic surgery physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $111.04 | $96.33 | 115% | above 73% of 42 Houston plastic surgery physicians |
| 99214Office visit, established patient, moderate complexity | $80.13 | $137.41 | 58% | above 2% of 42 Houston plastic surgery physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 74177CT abdomen and pelvis, with contrast | $161.40 | $300.72 | 54% | not typically billed by plastic surgery physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by plastic surgery 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 Luke Grome performs these services, and they are kept out of the benchmark above.