James Flack, M. D.
Psychiatry Physician · Houston, TX 77080 · NPI 1952315137 · 1 payer file
115%of Medicare
Cigna — Houston FlexCare pays James Flack, M. D. $110.38 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 $93.32 to $127.45; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston psychiatry physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Houston FlexCare | $110.38median of 2 rows · $93.32–$127.45 | $96.33 | 115% | above 79% of 858 all Houston clinicians on this plan |
| 99214Office visit, established patient, moderate complexity | Cigna — Houston FlexCare | $158.43median of 2 rows · $137.04–$179.82 | $137.41 | 115% | above 79% of 858 all Houston clinicians on this plan |
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Houston FlexCare | $93.53median of 2 rows · $88.24–$98.82 | $82.68 | 113% | above 79% of 858 all Houston clinicians on this plan |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Houston FlexCare | $155.75median of 2 rows · $147.33–$164.16 | $138.62 | 112% | above 76% of 858 all Houston clinicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston psychiatry physicians, same plan |
|---|---|---|---|---|---|
| 70553MRI brain, with and without contrast | Cigna — Houston FlexCare | $480.63 | $317.92 | 151% | not typically billed by psychiatry physicians |
| 72148MRI lumbar spine, without contrast | Cigna — Houston FlexCare | $288.04 | $192.38 | 150% | not typically billed by psychiatry physicians |
| 74177CT abdomen and pelvis, with contrast | Cigna — Houston FlexCare | $462.54 | $300.72 | 154% | not typically billed by psychiatry physicians |
| 77067Screening mammography, bilateral | Cigna — Houston FlexCare | $115.80 | $126.38 | 92% | not typically billed by psychiatry 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 James Flack, M. D. performs these services, and they are kept out of the benchmark above.