Lourdes Rodriguez
Behavior Analyst · Houston, TX 77011 · NPI 1760130074 · 1 payer file
59%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Lourdes Rodriguez $56.88 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 24 contract rows for this clinician and code, from $42.18 to $76.68; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston behavior analysts, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $56.88median of 24 rows · $42.18–$76.68 | $96.33 | 59% | above 1% of 149 Houston behavior analysts on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $82.06median of 24 rows · $62.15–$108.35 | $137.41 | 60% | above 1% of 149 Houston behavior analysts on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston behavior analysts, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $59.43median of 24 rows · $49.49–$73.84 | $82.68 | 72% | not typically billed by behavior analysts |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $100.12median of 24 rows · $83.53–$124.22 | $138.62 | 72% | not typically billed by behavior analysts |
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 Lourdes Rodriguez performs these services, and they are kept out of the benchmark above.