AMY D. MALPHRUS M.D.
NPI 1558424846
Psychiatry & Neurology - Neurology with Special Qualifications in Child Neurology in Houston, TX

Medicare Participation & PECOS Enrollment Status

Amy Malphrus 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.

Amy Malphrus 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: 2961411202

  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: I20191204002256

  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.

Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)

Continuous intraoperative neurophysiology monitoring is a service where a specialist oversees your nervous system's function during surgery, from a nearby or remote location. This is done every 15 minutes and is focused solely on you. It helps ensure surgical safety by identifying any potential nervous system changes promptly.

This service was performed 369 times for 86 patients

Measurement of brain wave activity (eeg) outside the brain during surgery

An EEG (Electroencephalogram) during surgery monitors brain activity. Electrodes on the scalp record brain wave patterns, helping doctors ensure the brain is functioning normally throughout the procedure.

This service was performed 12 times for 12 patients

Measurement of brain wave activity (eeg), digital analysis

The measurement of brain wave activity, or EEG, involves recording and analyzing electrical signals from your brain. Small sensors are placed on the scalp to capture these signals. This digital analysis helps in diagnosing conditions like epilepsy or sleep disorders.

This service was performed 503 times for 500 patients

Needle measurement and recording of electrical activity of muscles at bladder and bowel openings

This procedure involves inserting a small needle into muscles near the openings of your body's waste removal systems. The needle records the electrical activity of these muscles, providing essential information about their function. This is a safe, routine process.

This service was performed 45 times for 45 patients

Needle measurement of electrical activity in arm or leg muscles, 2 extremities

This procedure, known as an electromyography (EMG), involves inserting a small needle into your arm or leg muscles to measure their electrical activity. It helps diagnose conditions affecting nerves or muscles. It's generally painless, though you may feel some discomfort.

This service was performed 173 times for 172 patients

Needle measurement of electrical activity in arm or leg muscles, complete study

This procedure, known as an electromyography (EMG), involves inserting a small needle into your arm or leg muscles to measure their electrical activity. This complete study helps diagnose issues with nerves or muscles, providing valuable data for your treatment plan.

This service was performed 361 times for 181 patients

Needle measurement of electrical activity in arm or leg muscles, limited study

This procedure, known as an electromyography (EMG), involves placing tiny needles into your arm or leg muscles to measure their electrical activity. It's a limited study, meaning only specific muscles are tested. This helps identify any muscle or nerve dysfunction.

This service was performed 120 times for 60 patients

Needle measurement of electrical activity in arm, leg, trunk or head muscles, limited study

This procedure, known as an electromyography (EMG), involves using a needle to measure electrical activity in your muscles. It can help diagnose conditions affecting nerves or muscles. It's a limited study, meaning only specific muscles in the arm, leg, trunk, or head are examined.

This service was performed 213 times for 104 patients

Needle measurement of electrical activity in muscles on both sides of body

This procedure, known as electromyography, involves inserting tiny needles into muscles to measure their electrical activity. It helps identify muscle or nerve disorders. It's performed on both sides of the body for comparison. It's generally safe and may cause minimal discomfort.

This service was performed 127 times for 126 patients

Needle measurement of electrical activity in trunk or head muscles

This procedure, known as electromyography, involves inserting a fine needle into a muscle in your head or trunk to record its electrical activity. It helps identify problems related to muscles or nerves controlling these muscles. It's a safe, valuable tool for diagnosing various conditions.

This service was performed 41 times for 41 patients

Needle measurement of electrical activity in voice box muscles

This procedure involves a needle that measures the electrical activity in your voice box muscles. It helps detect any abnormalities or issues. It's similar to an EKG for your heart, but focuses on your voice box instead.

This service was performed 49 times for 49 patients

Nerve conduction, 1-2 studies

Nerve conduction studies are tests that measure how well your nerves are working. In a 1-2 studies procedure, a small electrical current is applied to 1 or 2 specific nerves. This helps to identify any nerve damage or dysfunction by assessing the speed and strength of nerve signals.

This service was performed 42 times for 42 patients

Nerve conduction, 3-4 studies

Nerve conduction studies are tests that measure how well your nerves are working. In a 3-4 studies procedure, electrical signals are sent through 3-4 nerves. The speed and strength of the signal's travel is recorded to detect any nerve damage or dysfunction.

This service was performed 93 times for 93 patients

Nerve conduction, 5-6 studies

Nerve conduction studies involve testing the speed and strength of signals traveling through your nerves. This helps identify any nerve damage or dysfunction. For 5-6 studies, this means multiple nerves will be tested. Small electrodes are placed on your skin to send and receive signals, causing minimal discomfort.

This service was performed 68 times for 68 patients

Nerve conduction, 7-8 studies

Nerve conduction studies involve testing the speed and strength of signals traveling through your nerves. This helps doctors identify nerve damage. In a 7-8 study procedure, 7-8 specific nerves are tested. You may feel a mild, brief tingling or shock during the test.

This service was performed 27 times for 27 patients

Nerve conduction, 9-10 studies

Nerve conduction studies involve sending small electrical shocks through the skin to measure how quickly nerves transmit signals. This helps detect nerve damage. 9-10 studies mean this process will be repeated on different nerves to gather comprehensive data.

This service was performed 14 times for 14 patients

Placement of skin electrodes and measurement of central motor stimulation in arms and legs

This procedure involves placing small patches (electrodes) on your skin over your arms and legs. These electrodes send harmless electrical signals to your muscles. The response is measured to assess the health and function of your nerves and muscles.

This service was performed 171 times for 170 patients

Placement of skin electrodes and measurement of stimulated sites on arms and legs

This procedure involves placing small pads (electrodes) on your arms and legs. These electrodes send gentle electric signals to specific areas, and the responses are measured. This helps assess the health of your nerves and muscles.

This service was performed 519 times for 516 patients

Testing of nerve-muscle junction

Testing of the nerve-muscle junction, also known as Electromyography (EMG), is a diagnostic procedure to evaluate the health of muscles and the nerve cells that control them. It involves a small device detecting electrical activity from your muscles to identify potential issues.

This service was performed 1,433 times for 516 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $33.51 for a new patient copayment and $25.67 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 77025 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. Amy Malphrus is affiliated with the following medical facilities:

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