Lisa Pham, DO
Developmental - Behavioral Pediatrics Physician · Houston, TX 77054 · NPI 1982961819 · 2 payer files
56%of Medicare
Cigna — Texas Connect (individual & family) pays Lisa Pham, DO $53.79 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 $53.79 to $53.79; the median is shown.
Negotiated rates vs Medicare
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston developmental - behavioral pediatrics physicians, same plan |
|---|---|---|---|---|---|
| 99213Office visit, established patient, low complexity | Cigna — Texas Connect (individual & family) | $53.79median of 2 rows · $53.79–$53.79 | $96.33 | 56% | above 8% of 1,164 all Houston clinicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $107.10median of 28 rows · $75.32–$142.79 | $96.33 | 111% | above 43% of 15 Houston developmental - behavioral pediatrics physicians on this plan | |
| 99214Office visit, established patient, moderate complexity | Cigna — Texas Connect (individual & family) | $84.39median of 2 rows · $84.39–$84.39 | $137.41 | 61% | above 8% of 1,164 all Houston clinicians on this plan |
| Aetna — Texas (office visit and psychotherapy codes only) | $155.63median of 28 rows · $115.67–$207.14 | $137.41 | 113% | above 43% of 15 Houston developmental - behavioral pediatrics physicians on this plan |
Also contracted — outside this specialty’s usual billing
| Service | Payer · plan | Negotiated | Medicare | % of Medicare | Among Houston developmental - behavioral pediatrics physicians, same plan |
|---|---|---|---|---|---|
| 90833Psychotherapy, 30 minutes, add-on to an office visit | Cigna — Texas Connect (individual & family) | $38.00median of 2 rows · $38.00–$38.00 | $82.68 | 46% | not typically billed by developmental - behavioral pediatrics physicians |
| 90838Psychotherapy, 60 minutes, add-on to an office visit | Cigna — Texas Connect (individual & family) | $101.00median of 2 rows · $101.00–$101.00 | $138.62 | 73% | not typically billed by developmental - behavioral pediatrics 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 Lisa Pham, DO performs these services, and they are kept out of the benchmark above.