Pamela Wilhite
Optician · Houston, TX 77002 · NPI 1881966729 · 1 payer file
61%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Pamela Wilhite $58.59 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 68 contract rows for this clinician and code, from $41.92 to $81.60; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston opticians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $58.59median of 68 rows · $41.92–$81.60 | $96.33 | 61% | above 2% of 21,862 all Houston clinicians on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $88.78median of 44 rows · $61.68–$118.37 | $137.41 | 65% | above 5% of 21,418 all Houston clinicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston opticians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $66.56median of 12 rows · $58.73–$78.30 | $82.68 | 81% | not typically billed by opticians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $115.61median of 12 rows · $102.01–$136.02 | $138.62 | 83% | not typically billed by opticians |
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 Pamela Wilhite performs these services, and they are kept out of the benchmark above.