Priya Kothapalli, M.D.
Interventional Cardiology Physician · Houston, TX 77030 · NPI 1780062158 · 1 payer file
155%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Priya Kothapalli, M.D. $149.00 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 12 contract rows for this clinician and code, from $113.20 to $184.81; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston interventional cardiology physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $149.00median of 12 rows · $113.20–$184.81 | $96.33 | 155% | above 100% of 77 Houston interventional cardiology physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $215.00median of 8 rows · $166.50–$263.50 | $137.41 | 156% | above 100% of 77 Houston interventional cardiology physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston interventional cardiology physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $145.40median of 8 rows · $130.50–$160.30 | $82.68 | 176% | not typically billed by interventional cardiology physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $243.62median of 8 rows · $218.58–$268.66 | $138.62 | 176% | not typically billed by interventional cardiology 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 Priya Kothapalli, M.D. performs these services, and they are kept out of the benchmark above.