Carol Lewis, MD, MPH
Otolaryngology Physician · Houston, TX 77030 · NPI 1952516882
134%of Medicare
BCBSTX pays Carol Lewis, MD, MPH $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 otolaryngology physicians |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $129.07 | $96.33 | 134% | above 82% of 132 Houston otolaryngology physicians |
| 99214Office visit, established patient, moderate complexity | $189.08 | $137.41 | 138% | above 89% of 132 Houston otolaryngology 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 otolaryngology physicians |
| 77067Screening mammography, bilateral | $186.80 | $126.38 | 148% | not typically billed by otolaryngology 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 Carol Lewis, MD, MPH performs these services, and they are kept out of the benchmark above.