Seema Lalani, M.D.
Clinical Genetics (M.D.) Physician · Houston, TX 77030 · NPI 1952470569
64%of Medicare
BCBSTX pays Seema Lalani, M.D. $61.45 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 clinical genetics (m.d.) physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $61.45 | $96.33 | 64% | above 27% of 16 Houston clinical genetics (m.d.) physicians |
| 99214Office visit, established patient, moderate complexity | $130.73 | $137.41 | 95% | above 27% of 16 Houston clinical genetics (m.d.) 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 clinical genetics (m.d.) physicians |
| 72148MRI lumbar spine, without contrast | $159.58 | $192.38 | 83% | not typically billed by clinical genetics (m.d.) physicians |
| 74177CT abdomen and pelvis, with contrast | $70.74 | $300.72 | 24% | not typically billed by clinical genetics (m.d.) physicians |
| 77067Screening mammography, bilateral | $29.61 | $126.38 | 23% | not typically billed by clinical genetics (m.d.) 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 Seema Lalani, M.D. performs these services, and they are kept out of the benchmark above.