RICHARD PROCTOR GARZA MD
NPI 1477530350
Radiology - Radiation Oncology in Austin, TX

Medicare Participation & PECOS Enrollment Status

Richard Garza 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.

Richard Garza 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: 446229785

  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: I20120910000396

  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.

Blood creatinine level

A blood creatinine level test measures the amount of creatinine in your blood. Creatinine is a waste product that your body produces when it uses energy. High levels may indicate that your kidneys aren't working properly. This test is often used to monitor kidney health.

This service was performed 75 times for 71 patients

Calculation of radiation therapy dose

Radiation therapy dose calculation is a process to determine the exact amount of radiation needed to treat a specific area in the body. This calculation helps ensure the treatment is effective while minimizing harm to healthy tissues. It's a key part of planning your radiation therapy.

This service was performed 805 times for 159 patients

Complex radiation therapy planning

Complex radiation therapy planning is a process to determine the most effective way to deliver radiation to a specific area in your body. It involves detailed imaging to map your body's structure, allowing for precise targeting of cancer cells while sparing healthy tissue.

This service was performed 152 times for 149 patients

Continuing radiation therapy consultation per week

Continuing radiation therapy consultation per week involves regular meetings with your healthcare team. These sessions help monitor your progress, manage side effects, and adjust your treatment plan if necessary. It's a key part of ensuring the effectiveness of your radiation therapy.

This service was performed 1,146 times for 173 patients

Ct guidance for insertion of radiation therapy fields

CT guidance for insertion of radiation therapy fields involves using a CT scan to accurately map the area of your body where radiation will be applied. This ensures the radiation targets only the necessary area, minimizing impact to healthy tissues.

This service was performed 5,657 times for 164 patients

Ct scan of abdomen and pelvis before and after contrast

A CT scan of your abdomen and pelvis with and without contrast helps visualize your internal organs better. Contrast is a special dye that improves the clarity of the images. It's taken orally or injected into your veins before the scan. The process is painless and quick.

This service was performed 58 times for 57 patients

Ct scan of abdomen and pelvis with contrast

A CT scan of the abdomen and pelvis with contrast is an imaging procedure. A special dye, called contrast, is used to make certain areas more visible. This can help identify issues such as infections, tumors, or other abnormalities. The procedure is painless and usually takes about 30 minutes.

This service was performed 13 times for 12 patients

Ct scan of abdomen and pelvis without contrast

A CT scan of the abdomen and pelvis is a non-invasive medical test. It uses special X-ray equipment to create detailed images of your abdominal and pelvic areas. This helps doctors examine organs, tissues, and vessels. No contrast dye is used in this procedure.

This service was performed 17 times for 16 patients

Design and construction of complex radiation treatment device

The design and construction of a complex radiation treatment device is a process where a specialized instrument is created. This device targets harmful cells with high-energy rays to destroy or damage them, while minimizing impact on healthy cells. This aids in treating conditions like cancer.

This service was performed 193 times for 148 patients

Design and construction of radiation treatment device for high precision radiation therapy

A radiation treatment device is custom-made for each patient to target cancer cells with high precision. It's designed to focus radiation on the tumor, sparing healthy tissue. This process ensures effective therapy while minimizing side effects.

This service was performed 341 times for 156 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 29 times for 28 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 225 times for 207 patients

High precision radiation therapy planning

High precision radiation therapy planning involves detailed mapping of your body to target cancer cells accurately. Advanced imaging techniques help identify the exact location of the tumor, minimizing harm to healthy tissues. This personalized approach enhances effectiveness and reduces side effects.

This service was performed 152 times for 151 patients

Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment

Image-guided robotic linear accelerator-based stereotactic radiosurgery is a precise, non-invasive treatment. It uses a machine to deliver high-dose radiation to a specific area in your body, like a tumor, in a single session or across multiple sessions.

This service was performed 11 times for 11 patients

Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatme

This treatment uses high-precision radiation, guided by real-time imaging, to target tumors. A robotic linear accelerator shapes the radiation to match the tumor, reducing harm to healthy tissue. The treatment is spread over 2-5 sessions and is limited to 5 sessions per course.

This service was performed 40 times for 11 patients

Injection, ceftriaxone sodium, per 250 mg

Ceftriaxone sodium is an antibiotic injection used to treat a variety of bacterial infections. Each injection contains 250 mg of the medicine. It works by stopping the growth of bacteria in your body.

This service was performed 129 times for 36 patients

Insertion of needle into vein for collection of blood sample

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

This service was performed 214 times for 166 patients

Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session

Intensity-modulated radiation therapy (IMRT) is a type of cancer treatment. It uses advanced technology to manipulate photon beams of radiation to conform to the shape of a tumor. IMRT allows for the radiation dose to conform more precisely to the three-dimensional shape of the tumor by modulating—or controlling—the intensity of the radiation beam. This can result in better tumor control and less harm to healthy tissue.

This service was performed 5,548 times for 159 patients

Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml

Low osmolar contrast material with 300-399 mg/ml iodine concentration is a diagnostic tool used in imaging procedures. It helps to enhance the visibility of specific areas in the body, aiding in accurate diagnosis. It's safe and generally well-tolerated by patients.

This service was performed 8,200 times for 77 patients

Management of cranial lesion surgery using radiation over multiple sessions

This procedure involves using targeted radiation to treat a lesion in the brain over several sessions. The radiation destroys the abnormal cells, helping to control or eliminate the lesion. It's a non-invasive treatment, meaning no surgical cuts are made.

This service was performed 11 times for 11 patients

New patient office or other outpatient visit, 60-74 minutes

This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.

This service was performed 241 times for 241 patients

Placement of device in prostate for radiation therapy

This procedure involves placing a small device in the gland below the bladder to deliver radiation therapy. This helps target therapy directly to the concerned area, potentially reducing side effects and improving treatment effectiveness.

This service was performed 39 times for 39 patients

Radiation treatment management, 5 treatment sessions

Radiation treatment management involves a series of 5 sessions where targeted radiation is used to destroy or shrink cancer cells in your body. Each session is carefully planned to maximize effectiveness while minimizing harm to healthy tissues. You may experience side effects which will be closely monitored and managed for your comfort.

This service was performed 1,130 times for 160 patients

Special medical radiation therapy consultation

A special medical radiation therapy consultation involves discussing the use of high-energy radiation to treat diseases, primarily cancer. It's a chance to understand the process, potential side effects, and benefits. It is a key step in planning your treatment.

This service was performed 12 times for 12 patients

Tissue marker, implantable, any type, each

An implantable tissue marker is a tiny device placed in the body to mark the location of a specific area. It helps doctors accurately identify the spot for future reference, such as during treatment or follow-up visits. It's a safe procedure and usually painless.

This service was performed 39 times for 39 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $43.5 for a new patient copayment and $17.98 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 78705 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 89.8, 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: 89.8 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: 88

  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.

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