Shiji Varghese
Acute Care Nurse Practitioner · Houston, TX 77008 · NPI 1730636291 · 1 payer file
162%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Shiji Varghese $156.06 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 $124.42 to $183.59; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston acute care nurse practitioners, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $156.06median of 20 rows · $124.42–$183.59 | $96.33 | 162% | above 88% of 469 Houston acute care nurse practitioners on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $226.37median of 20 rows · $182.72–$266.33 | $137.41 | 165% | above 88% of 468 Houston acute care nurse practitioners on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston acute care nurse practitioners, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $149.75median of 12 rows · $132.14–$176.17 | $82.68 | 181% | not typically billed by acute care nurse practitioners |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $260.12median of 12 rows · $229.52–$306.04 | $138.62 | 188% | not typically billed by acute care 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 Shiji Varghese performs these services, and they are kept out of the benchmark above.