Eric Hamill, M.D.
Ophthalmic Plastic and Reconstructive Surgery Physician · Houston, TX 77005 · NPI 1871905463
80%of Medicare
BCBSTX pays Eric Hamill, M.D. $76.70 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 ophthalmic plastic and reconstructive surgery physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $76.70 | $96.33 | 80% | above 70% of 24,819 all Houston clinicians |
| 99214Office visit, established patient, moderate complexity | $80.13 | $137.41 | 58% | above 26% of 24,759 all Houston clinicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $88.84 | $317.92 | 28% | not typically billed by ophthalmic plastic and reconstructive surgery physicians |
| 74177CT abdomen and pelvis, with contrast | $258.15 | $300.72 | 86% | not typically billed by ophthalmic plastic and reconstructive surgery 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 Eric Hamill, M.D. performs these services, and they are kept out of the benchmark above.