Michelle Cunningham, OD
Optometrist · Houston, TX 77204 · NPI 1740251859 · 1 payer file
68%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Michelle Cunningham, OD $65.46 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 158 contract rows for this clinician and code, from $41.92 to $110.33; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston optometrists, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $65.46median of 158 rows · $41.92–$110.33 | $96.33 | 68% | above 86% of 575 Houston optometrists on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $95.14median of 124 rows · $61.68–$161.01 | $137.41 | 69% | above 84% of 575 Houston optometrists on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston optometrists, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $66.56median of 60 rows · $57.67–$99.91 | $82.68 | 81% | not typically billed by optometrists |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $125.19median of 36 rows · $102.01–$166.92 | $138.62 | 90% | not typically billed by optometrists |
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 Michelle Cunningham, OD performs these services, and they are kept out of the benchmark above.