Eriko Kern, PA
Adult Psychiatric/Mental Health Clinical Nurse Specialist · Houston, TX 77055 · NPI 1932796422 · 2 payer files
56%of Medicare
Cigna — Texas Connect (individual & family) pays Eriko Kern, PA $53.79 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 2 contract rows for this clinician and code, from $53.79 to $53.79; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston adult psychiatric/mental health clinical nurse specialists, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Texas Connect (individual & family) | $53.79median of 2 rows · $53.79–$53.79 | $96.33 | 56% | above 8% of 1,164 all Houston clinicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $69.36median of 20 rows · $55.30–$81.60 | $96.33 | 72% | above 29% of 21,862 all Houston clinicians on this plan | |
| 99214Office visit, established patient, moderate complexity | Cigna — Texas Connect (individual & family) | $84.39median of 2 rows · $84.39–$84.39 | $137.41 | 61% | above 8% of 1,164 all Houston clinicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $100.61median of 20 rows · $81.21–$118.37 | $137.41 | 73% | above 33% of 21,418 all Houston clinicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston adult psychiatric/mental health clinical nurse specialists, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Texas Connect (individual & family) | $38.00median of 2 rows · $38.00–$38.00 | $82.68 | 46% | not typically billed by adult psychiatric/mental health clinical nurse specialists |
| Aetna — Texas (office visit and psychotherapy codes only) | $66.56median of 12 rows · $58.73–$78.30 | $82.68 | 81% | not typically billed by adult psychiatric/mental health clinical nurse specialists | |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Texas Connect (individual & family) | $101.00median of 2 rows · $101.00–$101.00 | $138.62 | 73% | not typically billed by adult psychiatric/mental health clinical nurse specialists |
| Aetna — Texas (office visit and psychotherapy codes only) | $115.61median of 12 rows · $102.01–$136.02 | $138.62 | 83% | not typically billed by adult psychiatric/mental health clinical nurse specialists |
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 Eriko Kern, PA performs these services, and they are kept out of the benchmark above.