LEE Ellis, M.D.
Surgical Oncology Physician · Houston, TX 77030 · NPI 1952409161
134%of Medicare
BCBSTX pays LEE Ellis, M.D. $129.07 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 surgical oncology physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $129.07 | $96.33 | 134% | above 35% of 55 Houston surgical oncology physicians |
| 99214Office visit, established patient, moderate complexity | $189.08 | $137.41 | 138% | above 44% of 55 Houston surgical oncology physicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $157.20 | $317.92 | 49% | not typically billed by surgical oncology physicians |
| 72148MRI lumbar spine, without contrast | $101.41 | $192.38 | 53% | not typically billed by surgical oncology physicians |
| 74177CT abdomen and pelvis, with contrast | $125.18 | $300.72 | 42% | not typically billed by surgical oncology physicians |
| 77067Screening mammography, bilateral | $186.80 | $126.38 | 148% | not typically billed by surgical oncology 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 LEE Ellis, M.D. performs these services, and they are kept out of the benchmark above.