Mary Washington, MD, FACP
Nephrology Physician · Houston, TX 77015 · NPI 1811992894 · 1 payer file
72%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Mary Washington, MD, FACP $69.35 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 28 contract rows for this clinician and code, from $55.29 to $81.59; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston nephrology physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $69.35median of 28 rows · $55.29–$81.59 | $96.33 | 72% | above 6% of 184 Houston nephrology physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $100.60median of 30 rows · $81.20–$118.37 | $137.41 | 73% | above 7% of 184 Houston nephrology physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston nephrology physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $66.56median of 18 rows · $58.72–$78.29 | $82.68 | 81% | not typically billed by nephrology physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $115.60median of 18 rows · $102.01–$136.02 | $138.62 | 83% | not typically billed by nephrology 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 Mary Washington, MD, FACP performs these services, and they are kept out of the benchmark above.