Caroline Dooley, MD
Critical Care Medicine (Internal Medicine) Physician · Houston, TX 77030 · NPI 1871014373
64%of Medicare
BCBSTX pays Caroline Dooley, MD $61.45 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 critical care medicine (internal medicine) physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $61.45 | $96.33 | 64% | above 21% of 116 Houston critical care medicine (internal medicine) physicians |
| 99214Office visit, established patient, moderate complexity | $130.73 | $137.41 | 95% | above 54% of 116 Houston critical care medicine (internal medicine) physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by critical care medicine (internal medicine) physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by critical care medicine (internal medicine) 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 Caroline Dooley, MD performs these services, and they are kept out of the benchmark above.