Barbara Cortes, MD
Ophthalmology Physician · Houston, TX 77030 · NPI 1861133845 · 1 payer file
117%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Barbara Cortes, MD $112.50 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 8 contract rows for this clinician and code, from $85.33 to $139.67; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston ophthalmology physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $112.50median of 8 rows · $85.33–$139.67 | $96.33 | 117% | above 85% of 170 Houston ophthalmology physicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $162.46median of 8 rows · $125.67–$199.24 | $137.41 | 118% | above 85% of 169 Houston ophthalmology physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston ophthalmology physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $108.58median of 8 rows · $97.28–$119.88 | $82.68 | 131% | not typically billed by ophthalmology 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 Cortes, MD performs these services, and they are kept out of the benchmark above.