Victoria Harms, LCSW
Clinical Social Worker · Houston, TX 77047 · NPI 1922767680 · 2 payer files
87%of Medicare
UnitedHealthcare — Optum Behavioral Health pays Victoria Harms, LCSW $84.06 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 clinical social workers, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | UnitedHealthcare — Optum Behavioral Health | $84.06 | $96.33 | 87% | above 1% of 68 Houston clinical social workers on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $72.25median of 106 rows · $53.11–$109.93 | $96.33 | 75% | above 52% of 780 Houston clinical social workers on this plan | |
| 99214Office visit, established patient, moderate complexity | UnitedHealthcare — Optum Behavioral Health | $118.50 | $137.41 | 86% | above 1% of 68 Houston clinical social workers on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $102.53median of 98 rows · $76.90–$159.65 | $137.41 | 75% | above 67% 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 | $65.10 | $82.68 | 79% | not typically billed by clinical social workers |
| Aetna — Texas (office visit and psychotherapy codes only) | $81.10median of 78 rows · $55.28–$105.60 | $82.68 | 98% | not typically billed by clinical social workers | |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | UnitedHealthcare — Optum Behavioral Health | $108.08 | $138.62 | 78% | not typically billed by clinical social workers |
| Aetna — Texas (office visit and psychotherapy codes only) | $122.70median of 56 rows · $92.58–$185.26 | $138.62 | 89% | 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 Victoria Harms, LCSW performs these services, and they are kept out of the benchmark above.