DR. MICHAEL JOHN MOUSTOUKAS MD
NPI 1174804413
Orthopaedic Surgery - Hand Surgery in Sarasota, FL

Medicare Participation & PECOS Enrollment Status

Michael Moustoukas is registered with Medicare and accepts claims assignment, this means the provider accepts the approved amount for the cost of rendered services as full payment. Participating providers may not charge beneficiaries more than the approved amount for their services. Please keep in mind that beneficiaries still have to pay a coinsurance or copayment amount for a visit or service.

Michael Moustoukas is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.

What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.

• Is the provider registered in PECOS? Yes

• PECOS PAC ID: 1052609492

  What is the PECOS Associate Control ID?
  A PAC ID is a unique 10-digit number assigned to an individual or organization healthcare provider in PECOS. The PAC ID is used to link together all the provider information, like tax identification numbers and organizational names. A PAC ID can be connected to multiple Enrollment IDs if an individual or organization has enrolled in PECOS more than once.

• PECOS Enrollment ID: I20170714001185

  What is the Provider Enrollment ID?
  The Enrollment ID is a unique alphanumeric 15-digit code assigned to each new provider's PECOS enrollment application. The Enrollment ID is used to link together all the provider enrollment information like enrollment type, state, provider specialty, and reassignment of benefits.

• Accepts Medicare Assignment? Yes

  What does it mean "accepts medicare assignment"?
  When a provider accepts Medicare assignment, the provider agrees to be paid directly by Medicare and to accept the payment amount approved by Medicare. Additionally, the provider agrees to not bill patients for more than the Medicare deductible and coinsurance amounts.
  A provider who doesn't accept assignment may charge you up to 15% over the Medicare-approved amount. This is known as the limiting charge. You may have to pay this amount, or it may be covered by another insurer.

• Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes

• Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes

• Eligible to Order or Refer a Home Health Agency (HHA): Yes

• Eligible to Order or Refer Power Mobility Devices: Yes

Provider Referred Orders for Durable Medical Equipment, Devices & Supplies

The following list reflects the services, supplies or durable medical equipment ordered by this provider to a DME supplier on behalf of patients. The information below is derived from Medicare claims data and reflects the BETOS category, HCPCS code information and the number times each service was submitted under the Medicare fee-for-service program.

Orthotic Devices

• DME-Orthotic Devices (DF000N)

  Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise (HCPCS:L3807)

  2 DME suppliers used 36 Medicare Claims 37 Services Paid

• DME-Orthotic Devices (DF000N)

  Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf (HCPCS:L3908)

  1 DME suppliers used 95 Medicare Claims 97 Services Paid

• DME-Orthotic Devices (DF000N)

  Hand finger orthosis, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise (HCPCS:L3923)

  1 DME suppliers used 47 Medicare Claims 49 Services Paid

• DME-Orthotic Devices (DF000N)

  Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), without joint/spring, extension/flexion (e.g., static or ring type), may include soft interface material, prefabricated, off-the-shelf (HCPCS:L3927)

  1 DME suppliers used 11 Medicare Claims 12 Services Paid

• DME-Orthotic Devices (DF000N)

  Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment (HCPCS:L3960)

  1 DME suppliers used 25 Medicare Claims 25 Services Paid

Areas of Expertise

The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.

Application of elbow to finger cast

An elbow to finger cast is applied to immobilize the arm from the elbow down to the fingers. This aids in healing fractures or severe sprains. The cast, made from plaster or fiberglass, wraps around the arm, providing support and limiting movement to promote recovery.

This service was performed 24 times for 24 patients

Aspiration and/or injection of fluid from large joint

This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.

This service was performed 143 times for 120 patients

Aspiration and/or injection of fluid from medium joint

This procedure involves a needle being inserted into a medium-sized joint, such as a knee or shoulder, to remove (aspirate) excess fluid. Sometimes, medication may also be injected into the joint to reduce inflammation and pain.

This service was performed 68 times for 56 patients

Aspiration and/or injection of fluid from small joint

This procedure involves inserting a thin needle into a small joint to remove (aspirate) or inject fluid. It can help diagnose conditions, relieve discomfort, or administer medication directly into the joint. It's generally safe with minimal discomfort.

This service was performed 141 times for 95 patients

Aspiration and/or injection of fluid large joint using ultrasound guidance

This procedure involves using ultrasound technology to accurately locate a large joint, usually the knee or shoulder. A needle is then inserted to either extract fluid (aspiration) or inject medication. The ultrasound helps ensure precision and safety.

This service was performed 648 times for 470 patients

Cast supplies, short arm cast, adult (11 years +), fiberglass

A short arm cast, made from fiberglass, is often used for fractures or injuries to the wrist or forearm in adults and children over 11. It's lightweight, durable, and can be molded to fit your arm comfortably. This cast allows for limited movement while ensuring proper healing.

This service was performed 23 times for 23 patients

Established patient office or other outpatient visit, 20-29 minutes

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

This service was performed 1,638 times for 892 patients

Established patient office or other outpatient visit, 30-39 minutes

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

This service was performed 460 times for 379 patients

Evaluation for occupational therapy, typically 30 minutes

An evaluation for occupational therapy is a process where a therapist assesses your physical and mental abilities to perform daily activities. This 30-minute session helps identify any difficulties you may have and develop strategies for improvement.

This service was performed 58 times for 56 patients

Incision of tendon covering of finger

This procedure involves making a small cut into the protective sheath around a finger tendon. It's typically done to relieve pressure or inflammation, improve finger movement, or treat conditions like trigger finger. It's a safe, often outpatient procedure.

This service was performed 12 times for 12 patients

Initial hospital inpatient care per day, typically 30 minutes

Initial hospital inpatient care refers to the first day of your stay in the hospital. This service typically includes a 30-minute check-up with a healthcare professional. They'll assess your health, discuss your condition, and plan your treatment. It's part of ensuring you receive the best possible care.

This service was performed 45 times for 45 patients

Injection into tendon or ligament

An injection into a tendon or ligament involves placing medication directly into these areas to help reduce inflammation and pain. It's often used for conditions like arthritis or tendonitis. The procedure is quick and usually involves a local anesthetic.

This service was performed 152 times for 92 patients

Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg

This injection contains two medications, betamethasone acetate and betamethasone sodium phosphate. It is used to reduce inflammation and pain. It's given by a healthcare professional, often directly into the area causing discomfort.

This service was performed 405 times for 228 patients

Injection, triamcinolone acetonide, not otherwise specified, 10 mg

Triamcinolone acetonide is a medication used to reduce inflammation in the body. It's given as a 10 mg injection for conditions like allergies, arthritis, or skin problems. The injection helps to decrease swelling, redness, and itching.

This service was performed 3,786 times for 529 patients

Melanoma (skin cancer) excision

Melanoma excision is a procedure where a surgeon removes melanoma, a type of skin cancer, and some surrounding healthy tissue. Local anesthesia is applied to numb the area. The goal is to completely remove the cancer and prevent its spread. Healing time varies.

This service was performed for 1-10 patients

New patient office or other outpatient visit, 45-59 minutes

This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.

This service was performed 909 times for 909 patients

Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and

This is a service where a doctor or authorized practitioner certifies that you require Medicare-covered home health services. They will communicate with the home health agency and review reports on your health status to ensure you receive appropriate care. This does not involve an in-person visit.

This service was performed 56 times for 51 patients

Prosthetic repair of shoulder joint, total shoulder

Total shoulder prosthetic repair is a surgical procedure to replace a damaged shoulder joint with artificial components. It aims to relieve pain and restore mobility. The procedure involves replacing the ball (humeral head) and socket (glenoid) of the shoulder joint.

This service was performed 44 times for 43 patients

Release of tendon connecting biceps muscle and shoulder using an endoscope

This procedure involves using a small camera, known as an endoscope, to view and release the tendon connecting your biceps muscle and shoulder. It can help reduce pain and improve mobility. The procedure is minimally invasive, promoting quicker recovery.

This service was performed 17 times for 17 patients

Release of wrist ligament using an endoscope

This procedure involves using a small camera, called an endoscope, to view and treat a tight wrist ligament. The endoscope is inserted through a tiny incision, reducing recovery time and scarring. It helps to relieve pain and improve wrist function.

This service was performed 56 times for 50 patients

Relocation of one muscle of shoulder or upper arm

Relocation of a shoulder or upper arm muscle is a procedure aimed at repositioning a displaced muscle. This helps improve mobility and reduce discomfort. It's performed under anesthesia and involves making an incision, moving the muscle, and then closing the wound.

This service was performed 39 times for 38 patients

Repair of shoulder rotator cuff using an endoscope

This procedure, known as arthroscopic rotator cuff repair, helps fix tears in the shoulder's rotator cuff. An endoscope, a small camera, is used to view the shoulder inside. Using small tools, the surgeon repairs the torn tissue. This minimally invasive approach often leads to a quicker recovery.

This service was performed 20 times for 20 patients

Shaving of part of shoulder bone and repair of ligament using an endoscope

This procedure involves using a tiny camera, called an endoscope, to view and repair a damaged shoulder ligament. Simultaneously, a small portion of the shoulder bone is shaved to alleviate discomfort and improve movement. It's a minimally invasive technique that aids in a quicker recovery.

This service was performed 16 times for 16 patients

Telephone medical discussion with physician, 5-10 minutes

A telephone medical discussion with a physician is a brief, 5-10 minute call where you can discuss your health concerns. It's a convenient way to receive medical advice without needing to visit a clinic. It's important to prepare questions in advance to make the most of this time.

This service was performed 17 times for 17 patients

Test or measurement for functional capacity, each 15 minutes

This procedure measures your functional capacity, or ability to perform tasks, over 15-minute intervals. It can help identify limitations or improvements in your physical abilities. The test may involve activities like walking, lifting, or bending.

This service was performed 40 times for 26 patients

Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes

This therapy involves exercises to boost strength, endurance, flexibility, and range of motion. Each session lasts 15 minutes. The goal is to improve physical function and overall health. It's a safe, beneficial method for enhancing well-being and fitness.

This service was performed 503 times for 59 patients

Therapy procedure using functional activities

A therapy procedure using functional activities encourages you to use your own body movements in day-to-day tasks to aid recovery. It aims to improve your mobility, strength, and overall health by incorporating therapeutic exercises into your routine.

This service was performed 573 times for 45 patients

Therapy procedure using manual technique, each 15 minutes

This therapy involves using hands-on techniques to help improve your body's movement and function. These techniques may include stretching, resistance exercises, or gentle pressure. Each session lasts 15 minutes and aims to relieve pain, promote healing, and improve your overall health.

This service was performed 56 times for 18 patients

Training for self-care or home management, each 15 minutes

This service involves training sessions, each lasting 15 minutes, focused on teaching you essential self-care or home management skills. You'll learn techniques to manage your health condition at home, promoting independence and enhancing your quality of life.

This service was performed 56 times for 44 patients

Treatment of 3 or more broken lower forearm bone pieces on thumb side inside wrist joint with placement of stabilizing device

This treatment involves repairing multiple fractures in the lower forearm near the thumb side of the wrist. A device is placed to stabilize the area, promoting proper healing. This procedure helps restore function and minimize discomfort.

This service was performed 42 times for 42 patients

Treatment of broken neck of thigh bone with bone implant

This procedure involves repairing a fractured thigh bone by inserting a bone implant. The implant helps stabilize the bone, allowing it to heal correctly. It's performed under anesthesia and requires a hospital stay for recovery.

This service was performed 30 times for 28 patients

Treatment of upper end of broken thigh bone with placement of stabilizing device or prosthetic replacement

This procedure involves treating a fracture at the top of your thigh bone. A stabilizing device or prosthetic replacement is placed to aid in healing. This helps restore mobility and function while reducing pain. The treatment aims for a quick and safe recovery.

This service was performed 12 times for 12 patients

Upper limb (arm) arthroscopy (minimally invasive joint repair)

Upper limb arthroscopy is a minimally invasive procedure used to examine and treat issues within your arm's joints. A small camera, called an arthroscope, is inserted through a tiny incision, providing a clear view of the joint. This method often results in less pain and faster recovery compared to open surgery.

This service was performed for 115 patients

X-ray of collar bone

An X-ray of the collar bone is a quick, painless test that produces images of this bone to help diagnose fractures or other abnormalities. The procedure involves a small amount of radiation to capture these images. During the test, you'll be asked to stay still to ensure clear results.

This service was performed 24 times for 12 patients

X-ray of elbow, 2 views

An elbow X-ray, 2 views, is a quick, painless imaging test. It uses a small amount of radiation to produce detailed images of your elbow from two different angles. This helps in diagnosing conditions like fractures, infection, or arthritis. It's a safe and effective way to monitor your elbow health.

This service was performed 158 times for 98 patients

X-ray of finger, minimum of 2 views

An X-ray of the finger involves capturing images of your finger from at least two different angles. This non-invasive procedure helps in visualizing the bones and joints, aiding in the diagnosis of fractures, infections, or other abnormalities. Minimal discomfort may be experienced.

This service was performed 132 times for 94 patients

X-ray of hand, 2 views

An X-ray of the hand, 2 views, is a non-invasive imaging test that uses a small amount of radiation to produce pictures of the bones in your hand. Two different angles are captured to provide a comprehensive view. This helps in diagnosing injuries or conditions affecting your hand.

This service was performed 24 times for 20 patients

X-ray of hand, minimum of 3 views

An X-ray of the hand, minimum of 3 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of the bones in your hand from different angles. This helps in diagnosing fractures, infections, arthritis, or other abnormalities. It's quick and painless.

This service was performed 160 times for 114 patients

X-ray of hip, 1 view

An X-ray of the hip, 1 view, is a quick, painless test where a small amount of radiation is used to produce images of the hip joint. This helps in diagnosing conditions like arthritis or fractures. You'll be positioned so that the X-ray machine can capture the best image of your hip.

This service was performed 56 times for 33 patients

X-ray of shoulder, minimum of 2 views

An X-ray of the shoulder, with a minimum of 2 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of your shoulder bones. This helps in diagnosing conditions like fractures, arthritis, or other abnormalities. The procedure is quick and painless.

This service was performed 930 times for 601 patients

X-ray of thigh bone, minimum 2 views

An X-ray of the thigh bone is a non-invasive imaging test. It involves passing a small amount of radiation through the thigh to produce images of the bone structure. At least two different angles are captured for a comprehensive view. This helps detect fractures, infections, or other abnormalities.

This service was performed 27 times for 13 patients

X-ray of upper arm, minimum of 2 views

An X-ray of the upper arm with a minimum of 2 views involves capturing images of your arm from different angles. This helps in assessing the bones and surrounding tissues for any abnormalities or injuries. It's a quick, painless procedure.

This service was performed 31 times for 16 patients

X-ray of wrist, 2 views

An X-ray of the wrist, 2 views, is a diagnostic procedure where two different images of your wrist are taken using a small amount of radiation. This helps identify any abnormalities or injuries such as fractures or arthritis. It's a quick, non-invasive process.

This service was performed 128 times for 71 patients

X-ray of wrist, minimum of 3 views

An X-ray of the wrist, minimum of 3 views, is a diagnostic procedure that uses radiation to create images of your wrist from different angles. This helps detect fractures, infections, or other abnormalities for accurate diagnosis and treatment planning.

This service was performed 213 times for 120 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $21.9 for a new patient copayment and $17.51 for an established patient copayment.

The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.

For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.

The prices below reflect the costs for new and established patients in the 34232 ZIP code area.

* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.

Overall MIPS Quality Performance

The provider participated in CMS Quality Payment Program under the Merit-based Incentive Payment System (MIPS) and has an overall final score of 75, based on four performance areas: quality, improvement activities, promoting interoperability, and cost. The purpose of this information is to help people with Medicare make informed decisions and incentivize doctors and clinicians to maximize performance.

The Merit-based Incentive Payment System (MIPS) is a way providers could use to participate in CMS Quality Payment Program (QPP). The MIPS program affects clinician reimbursement for Part B covered professional services and also rewards them for improving the quality of patient care and outcomes.

• Final Score: 75 out of 100

  The MIPS program evaluates providers across multiple categories with a specific weight for each category resulting a in a MIPS final score that ranges from 0 to 100 points. The MIPS Final Score determines whether providers receive a negative, neutral or positive MIPS payment adjustment.
  
  

• Quality Score: N/A

  The Quality category assesses providers performance on clinical practices and patient outcomes under the traditional MIPS program. The quality measures help identify the quality of healthcare processes, outcomes, and patient experiences. The Quality measure category compromises 40% providers final MPIS scores.
  
  There are six collection types for MIPS quality measures: Electronic Clinical Quality Measures (eCQMs), MIPS Clinical Quality Measures (CQMs), Qualified Clinical Data Registry (QCDR) Measures, Medicare Part B claims measures, CMS Web Interface measures and The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS Survey.
  
  

• Promoting Interoperability Score: N/A

  The Interoperability category measures the providers ability to use technology to exchange and make use of healthcare information in a way that is less burdensome and improves outcomes. The Interoperability measure category compromises 25% providers final MPIS scores.
  
  The MIPS Interoperability measure focuses on the use of certified electronic health record technology (CEHRT) to improve patient access health information, the exchange of information between clinicians and pharmacies and the systematic collection, analysis, and interpretation of healthcare data.

• Improvement Activities Score: N/A

  The Improvement Activities performance category evaluates the providers participation in clinical activities that support the improvement of clinical practice, care delivery, and outcomes. Providers have the option to choose 2 to 4 activities from an inventory of over 100 improvement activities. Providers typically choose the activities that best fit their needs. The improvement activities measure category compromises 15% providers final MPIS scores.
  
  The Improvement measures aim to better patient engagement, patient safety and other areas of patient care. The Improvement Activities category compromises 15% of providers final MPIS scores.

• Cost Score: N/A

  The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.
  
  Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

• Cost Score: N/A

  The Cost performance category asses the amount and types of services provided and how clinicians coordinate care and seek improvement of health outcomes by ensuring patients receive the appropriate services.
  
  Although providers don't determine the price of healthcare services they are important in delivering high-quality care at a reasonable cost. The Cost measures category compromises 20% of providers final MPIS scores.

Find Provider Hospital Affiliations - Privileges

Doctors and physicians must apply for hospital privileges to treat patients at hospitals. Find out if your doctor has privileges to practice at your preferred hospital by using the hospital affiliation information below based on recent medical claims.

Hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the medical claims NPI number and place of service code. Additionally, to further determine provider hospital affiliation the clinician must have provided services to at least three patients on three different dates in the last 12 months. Michael Moustoukas is affiliated with the following medical facilities:

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Frequently Asked Questions