Rocky Tsang, M.D.
Pediatric Critical Care Medicine Physician · Houston, TX 77030 · NPI 1750547220
121%of Medicare
BCBSTX pays Rocky Tsang, M.D. $116.53 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 pediatric critical care medicine physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $116.53 | $96.33 | 121% | above 21% of 118 Houston pediatric critical care medicine physicians |
| 99214Office visit, established patient, moderate complexity | $123.69 | $137.41 | 90% | above 9% of 118 Houston pediatric critical care medicine physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $88.84 | $317.92 | 28% | not typically billed by pediatric critical care medicine physicians |
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by pediatric critical care medicine physicians |
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by pediatric critical care medicine physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by pediatric critical care medicine 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 Rocky Tsang, M.D. performs these services, and they are kept out of the benchmark above.