Nancy Albin, OTR
Occupational Therapist · Houston, TX 77090 · NPI 1891750972 · 1 payer file
60%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Nancy Albin, OTR $58.11 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 24 contract rows for this clinician and code, from $43.13 to $78.30; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston occupational therapists, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $58.11median of 24 rows · $43.13–$78.30 | $96.33 | 60% | above 3% of 35 Houston occupational therapists on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $83.80median of 48 rows · $63.51–$110.54 | $137.41 | 61% | above 3% of 35 Houston occupational therapists on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston occupational therapists, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $56.73median of 24 rows · $47.29–$70.42 | $82.68 | 69% | not typically billed by occupational therapists |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $95.96median of 24 rows · $80.20–$118.85 | $138.62 | 69% | not typically billed by occupational therapists |
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 Nancy Albin, OTR performs these services, and they are kept out of the benchmark above.