Melinda Ortega, LCSW
Clinical Social Worker · Houston, TX 77011 · NPI 1841802246 · 1 payer file
62%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Melinda Ortega, LCSW $59.75 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 190 contract rows for this clinician and code, from $40.45 to $81.24; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston clinical social workers, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $59.75median of 190 rows · $40.45–$81.24 | $96.33 | 62% | above 4% of 780 Houston clinical social workers on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $88.32median of 204 rows · $59.55–$118.49 | $137.41 | 64% | above 4% of 783 Houston clinical social workers on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston clinical social workers, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $59.32median of 96 rows · $46.68–$77.49 | $82.68 | 72% | not typically billed by clinical social workers |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $100.31median of 92 rows · $78.78–$137.08 | $138.62 | 72% | not typically billed by clinical social workers |
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 Melinda Ortega, LCSW performs these services, and they are kept out of the benchmark above.