Margarita Kogan
Social Worker · Houston, TX 77079 · NPI 1922504125 · 2 payer files
81%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Margarita Kogan $78.13 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 80 contract rows for this clinician and code, from $53.11 to $109.93; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston social workers, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $78.13median of 80 rows · $53.11–$109.93 | $96.33 | 81% | above 96% of 69 Houston social workers on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $102.83median of 68 rows · $76.90–$159.65 | $137.41 | 75% | above 88% of 69 Houston social workers on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston 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 social workers |
| Aetna — Texas (office visit and psychotherapy codes only) | $76.20median of 60 rows · $55.28–$105.60 | $82.68 | 92% | not typically billed by social workers | |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $122.70median of 54 rows · $92.58–$185.26 | $138.62 | 89% | not typically billed by 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 Margarita Kogan performs these services, and they are kept out of the benchmark above.