Sebastian Weaver, LMSW
Clinical Social Worker · Houston, TX 77040 · NPI 1952014458 · 1 payer file
71%of Medicare
Aetna — Texas (office visit and psychotherapy codes only) pays Sebastian Weaver, LMSW $68.42 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 20 contract rows for this clinician and code, from $53.95 to $80.50; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston clinical social workers, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Aetna — Texas (office visit and psychotherapy codes only) | $68.42median of 20 rows · $53.95–$80.50 | $96.33 | 71% | above 16% of 780 Houston clinical social workers on this plan |
| 99214Office visit, established patient, moderate complexity | Aetna — Texas (office visit and psychotherapy codes only) | $99.31median of 20 rows · $79.48–$116.83 | $137.41 | 72% | above 30% 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 | Aetna — Texas (office visit and psychotherapy codes only) | $65.67median of 24 rows · $57.94–$77.26 | $82.68 | 79% | not typically billed by clinical social workers |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Aetna — Texas (office visit and psychotherapy codes only) | $115.61median of 18 rows · $102.01–$136.02 | $138.62 | 83% | 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 Sebastian Weaver, LMSW performs these services, and they are kept out of the benchmark above.