Theodore Rosen, MD
Dermatology Physician · Houston, TX 77030 · NPI 1881790749
64%of Medicare
BCBSTX pays Theodore Rosen, 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 dermatology physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $61.45 | $96.33 | 64% | above 67% of 118 Houston dermatology physicians |
| 99214Office visit, established patient, moderate complexity | $80.13 | $137.41 | 58% | above 2% of 118 Houston dermatology physicians |
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 dermatology physicians |
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by dermatology physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by dermatology 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 Theodore Rosen, MD performs these services, and they are kept out of the benchmark above.