Gloria Tijerina, LCSW
Clinical Social Worker · Houston, TX 77006 · NPI 1902029895 · 2 payer files
74%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Gloria Tijerina, LCSW $70.92 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 70 contract rows for this clinician and code, from $52.15 to $95.04; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston clinical social workers, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $70.92median of 70 rows · $52.15–$95.04 | $96.33 | 74% | above 48% of 780 Houston clinical social workers on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $101.72median of 80 rows · $76.78–$137.50 | $137.41 | 74% | above 66% of 783 Houston clinical social workers on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston clinical social workers, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | UnitedHealthcare — Optum Behavioral Health | $72.38 | $82.68 | 88% | not typically billed by clinical social workers |
| Aetna — Texas (office visit and psychotherapy codes only) | $76.20median of 36 rows · $57.67–$89.65 | $82.68 | 92% | not typically billed by clinical social workers | |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $121.25median of 24 rows · $102.01–$149.26 | $138.62 | 87% | not typically billed by clinical social workers |
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 Gloria Tijerina, LCSW performs these services, and they are kept out of the benchmark above.