GENE R HOWARD MD
NPI 1255343794
Ophthalmology in Mount Pleasant, SC

Medicare Participation & PECOS Enrollment Status

Gene Howard 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.

Gene Howard 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: 8426056177

  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: I20061114000085

  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

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.

Biopsy of eyelid

A biopsy of the eyelid is a procedure where a small piece of tissue is taken from your eyelid for examination. It helps identify any abnormal growth like a lump or cyst. It's done under local anesthesia, so you won't feel pain during the process.

This service was performed 28 times for 28 patients

Creation of drainage tract from tear sac to nasal cavity

This procedure, called Dacryocystorhinostomy, creates a new pathway for tears to drain from your eye into your nose. It's done when the natural tear duct is blocked or not working properly. It helps prevent tear overflow and eye infections.

This service was performed 24 times for 24 patients

Diagnostic exam of nasal passages using an endoscope

A diagnostic exam of nasal passages using an endoscope is a non-invasive procedure. A small, flexible tube with a light and camera at the end, called an endoscope, is inserted into the nose. This allows the doctor to view the nasal passages and sinuses, helping to identify any issues.

This service was performed 32 times for 30 patients

Dilation of tear drainage opening

Dilation of the tear drainage opening is a minor procedure to widen the tear ducts and improve tear flow. A thin instrument is gently inserted into the tear duct to expand it. This can help alleviate symptoms like watery eyes or infections caused by blocked tear ducts.

This service was performed 32 times for 29 patients

Established patient office or other outpatient visit, 10-19 minutes

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

This service was performed 177 times for 149 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 61 times for 61 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 219 times for 214 patients

Established patient problem focused exam of visual system

This is a routine check-up for existing patients focusing on the visual system. It involves examining your eyes to detect any potential issues or changes in your vision. It's a crucial part of maintaining good eye health.

This service was performed 64 times for 57 patients

Exam of visual field with intermediate testing

An exam of the visual field with intermediate testing is a procedure that checks your peripheral (side) vision. It helps to identify blind spots which could be a sign of eye diseases. This non-invasive test is painless and quick.

This service was performed 387 times for 386 patients

Extensive repair of turning-inward eyelid defect

This procedure helps correct an eyelid defect where the eyelid turns inward, causing discomfort or vision issues. A surgeon makes precise adjustments to the eyelid's structure, alleviating the inward turn and improving eye health and comfort.

This service was performed 36 times for 35 patients

Extensive repair of turning-outward eyelid defect

This procedure corrects an eyelid defect where the eyelid turns outward, exposing the eye. The extensive repair involves surgical techniques to reshape the eyelid and ensure it functions properly. This helps protect the eye and improve comfort.

This service was performed 58 times for 57 patients

Full thickness skin graft to nose, ears, eyelids, or lips, 20.0 sq cm or less

A full thickness skin graft is a procedure where a layer of skin is taken from one area of the body and transplanted to another. If it's done on the nose, ears, eyelids, or lips, it helps restore these areas when damaged. The size of the graft is 20.0 sq cm or less.

This service was performed 12 times for 12 patients

Injection into skin growth, 1-7 growths

This procedure involves injecting medication into 1-7 skin growths. The medication helps to reduce the size of the growths or completely eliminate them. It's a simple, quick, and usually painless process performed by a medical professional.

This service was performed 11 times for 11 patients

Injection of chemical for paralysis of nerve muscles on side of face

This procedure involves injecting a chemical into specific facial nerves, causing temporary muscle paralysis. It's used to treat conditions like facial spasms or wrinkles. The effects are usually temporary, requiring repeat treatments.

This service was performed 140 times for 49 patients

Injection, onabotulinumtoxina, 1 unit

Onabotulinumtoxina, also known as Botox, is a medication injected into muscles. It's used to treat various conditions by blocking nerve activity in the muscles, causing a temporary reduction in muscle activity. The units refer to the dosage.

This service was performed 8,472 times for 49 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 40 patients

New patient office or other outpatient visit, 15-29 minutes

This service involves an initial visit to the doctor's office or other outpatient setting. It typically lasts between 15-29 minutes. The doctor will review your medical history, conduct a physical examination, and discuss your health concerns. It's a chance to establish your health baseline and address any immediate medical issues.

This service was performed 95 times for 95 patients

New patient office or other outpatient visit, 30-44 minutes

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

This service was performed 102 times for 102 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 387 times for 387 patients

New patient problem focused exam of visual system

A new patient problem-focused exam of the visual system is a basic evaluation of your eyes and vision. It includes checking your eye movements, visual acuity, and general eye health. It helps detect any potential issues early for timely treatment.

This service was performed 68 times for 68 patients

Photography of content of eyes

Photography of the content of eyes, also known as ocular photography, captures detailed images of different parts of the eye. It helps identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. The process is non-invasive and painless.

This service was performed 891 times for 872 patients

Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less

This procedure involves preparing a specific area of your body, such as the face, scalp, neck, or extremities, for a skin graft. A skin graft is a surgical procedure where healthy skin is transferred to an area of the body that has lost skin. This preparation ensures the graft will take hold effectively.

This service was performed 11 times for 11 patients

Probing of nasal tear duct

Probing of the nasal tear duct is a procedure to treat blocked tear ducts. A thin, flexible instrument is gently inserted into the tear duct to clear any obstruction, allowing tears to drain normally again. This procedure is typically quick and can help to alleviate symptoms like excessive tearing or infection.

This service was performed 33 times for 33 patients

Reconstruction of eyelid by transfer of eyelid tissue from opposite eyelid

This procedure involves transferring eyelid tissue from one eyelid to the other to repair damage or defects. This helps restore function and appearance. It's performed under anesthesia and recovery varies, with follow-ups to ensure healing.

This service was performed 13 times for 12 patients

Removal of excessive skin and fat of upper eyelid

This procedure, also known as upper eyelid surgery, is performed to remove excess skin and fat from the upper eyelid. It can help improve vision if heavy eyelids hinder it, and can also enhance the appearance of the eyes. It's a common, safe procedure.

This service was performed 158 times for 158 patients

Removal of eyelashes using forceps

The removal of eyelashes using forceps is a simple procedure where a medical professional gently extracts unwanted or problematic eyelashes with a specialized tool. This is often done to alleviate discomfort or to treat conditions like trichiasis, where eyelashes grow inward.

This service was performed 21 times for 14 patients

Removal of foreign body in nose

Removal of a foreign body in the nose involves a healthcare professional carefully extracting an object lodged in your nasal passage. This is done using specialized tools to ensure safety and comfort. The procedure helps to prevent infections, nosebleeds, or breathing issues.

This service was performed 22 times for 21 patients

Removal of growth of eyelid

The removal of an eyelid growth is a procedure performed to eliminate abnormal tissue from your eyelid. It's generally a quick, outpatient treatment. The doctor numbs your eyelid, carefully removes the growth, and may stitch the area if necessary. This can help maintain eye health and vision.

This service was performed 136 times for 103 patients

Removal of over 1/4 of eyelid margin and repair of eyelid

This procedure involves the removal of more than a quarter of the eyelid margin due to conditions like tumors, infections, or injuries. The remaining part is then repaired to restore normal function and appearance. It's a safe procedure done under local anesthesia.

This service was performed 15 times for 13 patients

Repair of brow paralysis

Repair of brow paralysis is a procedure aimed to restore function and symmetry to the face. This is achieved by adjusting muscles and nerves in the brow area. It can help improve the appearance and movement of the forehead and eyebrows, enhancing overall facial expressions.

This service was performed 22 times for 22 patients

Repair of tendon of upper eyelid

Repair of the tendon of the upper eyelid is a surgical procedure aimed at fixing a droopy eyelid. This condition can affect your vision and appearance. The procedure involves tightening the tendon to lift the eyelid to its normal position, improving both function and aesthetics.

This service was performed 178 times for 177 patients

Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less

This procedure involves repairing a wound on the eyelids, nose, ears, or lips by moving a small piece of skin (10.0 sq cm or less) from one area to another. The goal is to heal the wound and restore the function and appearance of the affected area.

This service was performed 19 times for 19 patients

Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.1-30.0 sq cm

This procedure involves repairing a wound on the eyelids, nose, ears, or lips by transferring skin from another part of the body. The size of the skin transferred will be between 10.1 to 30.0 square centimeters. It is performed to restore function and appearance.

This service was performed 14 times for 14 patients

Snip incision of tear duct at inner corner of eye

This procedure involves making a small cut in your tear duct, located at the inner corner of your eye. It's typically done to relieve blockage, helping tears drain properly from your eye. It's a common, quick procedure with minimal discomfort.

This service was performed 12 times for 11 patients

Temporary closure of eyelids by suture

Temporary closure of eyelids by suture is a medical procedure to protect the eye. It involves stitching the eyelids together to prevent them from opening, often due to injury or disease. This helps to heal the eye by reducing exposure and irritation.

This service was performed 12 times for 12 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $31.01 for a new patient copayment and $16.78 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 29464 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 94.46, 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 provider also has detailed performance information the following quality measures: .

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: 94.46 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: 91.57

  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: 97

  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: 40

  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.

MIPS Quality Measures

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