Scott Lemaire, M.D.
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician · Houston, TX 77030 · NPI 1932289337
54%of Medicare
BCBSTX pays Scott Lemaire, M.D. $51.98 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 | BCBSTX | Medicare | % of Medicare | Among Houston thoracic surgery (cardiothoracic vascular surgery) physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $51.98 | $96.33 | 54% | above 10% of 100 Houston thoracic surgery (cardiothoracic vascular surgery) physicians |
| 99214Office visit, established patient, moderate complexity | $80.13 | $137.41 | 58% | above 6% of 100 Houston thoracic surgery (cardiothoracic vascular surgery) physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $88.84 | $317.92 | 28% | not typically billed by thoracic surgery (cardiothoracic vascular surgery) physicians |
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by thoracic surgery (cardiothoracic vascular surgery) physicians |
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by thoracic surgery (cardiothoracic vascular surgery) physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by thoracic surgery (cardiothoracic vascular surgery) physicians |
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 Scott Lemaire, M.D. performs these services, and they are kept out of the benchmark above.