Barbara Wilson, MD,FACS
Surgery Physician · Houston, TX 77030 · NPI 1780646760
54%of Medicare
BCBSTX pays Barbara Wilson, MD,FACS $51.98 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 surgery physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $51.98 | $96.33 | 54% | above 3% of 234 Houston surgery physicians |
| 99214Office visit, established patient, moderate complexity | $80.13 | $137.41 | 58% | above 1% of 234 Houston surgery physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by surgery 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 Barbara Wilson, MD,FACS performs these services, and they are kept out of the benchmark above.