Thomas Gillen, PA
Physician Assistant · Houston, TX 77065 · NPI 1902845571 · 1 payer file
62%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Thomas Gillen, PA $60.08 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 56 contract rows for this clinician and code, from $47.00 to $81.60; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston physician assistants, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $60.08median of 56 rows · $47.00–$81.60 | $96.33 | 62% | above 7% of 1,220 Houston physician assistants on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $88.78median of 58 rows · $69.02–$118.37 | $137.41 | 65% | above 7% of 1,217 Houston physician assistants on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston physician assistants, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $62.64median of 24 rows · $49.92–$78.30 | $82.68 | 76% | not typically billed by physician assistants |
| 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 physician assistants |
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 Thomas Gillen, PA performs these services, and they are kept out of the benchmark above.