Monica Contreras, PA-C
Physician Assistant · Houston, TX 77054 · NPI 1912070475 · 2 payer files
80%of Medicare
UnitedHealthcare — Optum Behavioral Health pays Monica Contreras, PA-C $77.20 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 | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston physician assistants, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | UnitedHealthcare — Optum Behavioral Health | $77.20 | $96.33 | 80% | above 11% of 19 Houston physician assistants on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $65.46median of 230 rows · $52.15–$81.60 | $96.33 | 68% | above 20% of 1,220 Houston physician assistants on this plan | |
| 99214Office visit, established patient, moderate complexity | UnitedHealthcare — Optum Behavioral Health | $109.17 | $137.41 | 79% | above 0% of 19 Houston physician assistants on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $95.14median of 236 rows · $76.78–$118.37 | $137.41 | 69% | above 19% 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 | UnitedHealthcare — Optum Behavioral Health | $64.63 | $82.68 | 78% | not typically billed by physician assistants |
| Aetna — Texas (office visit and psychotherapy codes only) | $65.96median of 24 rows · $57.67–$78.30 | $82.68 | 80% | not typically billed by physician assistants | |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | UnitedHealthcare — Optum Behavioral Health | $99.08 | $138.62 | 71% | not typically billed by physician assistants |
| Aetna — Texas (office visit and psychotherapy codes only) | $115.61median of 24 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 Monica Contreras, PA-C performs these services, and they are kept out of the benchmark above.