Paul Jordan, ACNP
Registered Nurse · Houston, TX 77070 · NPI 1962690263
46%of Medicare
BCBSTX pays Paul Jordan, ACNP $44.19 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 registered nurses |
|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | $44.19 | $96.33 | 46% | above 22% of 24,819 all Houston clinicians |
| 99214Office visit, established patient, moderate complexity | $94.00 | $137.41 | 68% | above 53% of 24,759 all Houston clinicians |
Also contracted — outside this specialty’s usual billing
| Service | BCBSTX | Medicare | % | |
|---|---|---|---|---|
| 70553MRI brain, with and without contrast | $226.31 | $317.92 | 71% | not typically billed by registered nurses |
| 72148MRI lumbar spine, without contrast | $135.65 | $192.38 | 71% | not typically billed by registered nurses |
| 74177CT abdomen and pelvis, with contrast | $60.13 | $300.72 | 20% | not typically billed by registered nurses |
| 77067Screening mammography, bilateral | $25.17 | $126.38 | 20% | not typically billed by registered nurses |
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 Paul Jordan, ACNP performs these services, and they are kept out of the benchmark above.