Claire Berry, M.ED., LPCA
Mental Health Counselor · Houston, TX 77023 · NPI 1801523493 · 1 payer file
112%of Medicare
Cigna — Texas Connect (individual & family) pays Claire Berry, M.ED., LPCA $107.97 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 | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston mental health counselors, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Texas Connect (individual & family) | $107.97 | $96.33 | 112% | above 0% of 20 Houston mental health counselors on this plan |
| 99214Office visit, established patient, moderate complexity | Cigna — Texas Connect (individual & family) | $156.34 | $137.41 | 114% | above 0% of 20 Houston mental health counselors on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston mental health counselors, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Texas Connect (individual & family) | $94.48 | $82.68 | 114% | not typically billed by mental health counselors |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Texas Connect (individual & family) | $152.97 | $138.62 | 110% | not typically billed by mental health counselors |
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 Claire Berry, M.ED., LPCA performs these services, and they are kept out of the benchmark above.