JAMES W SEHLOFF MD
NPI 1619923406
Internal Medicine - Pulmonary Disease in Baraboo, WI

Medicare Participation & PECOS Enrollment Status

James Sehloff 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.

James Sehloff 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: 941114995

  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: I20100607000303

  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.

Durable Medical Equipment

• DME-Other DME (DE001N)

  Tubing with integrated heating element for use with positive airway pressure device (HCPCS:A4604)

  17 DME suppliers used 259 Medicare Claims 259 Services Paid

• DME-Other DME (DE000N)

  Tracheal suction catheter, any type other than closed system, each (HCPCS:A4624)

  1 DME suppliers used 12 Medicare Claims 830 Services Paid

• DME-Other DME (DE000N)

  Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable (HCPCS:A7005)

  3 DME suppliers used 12 Medicare Claims 13 Services Paid

• DME-Other DME (DE001N)

  Full face mask used with positive airway pressure device, each (HCPCS:A7030)

  18 DME suppliers used 460 Medicare Claims 460 Services Paid

• DME-Other DME (DE001N)

  Face mask interface, replacement for full face mask, each (HCPCS:A7031)

  16 DME suppliers used 471 Medicare Claims 1106 Services Paid

• DME-Other DME (DE001N)

  Cushion for use on nasal mask interface, replacement only, each (HCPCS:A7032)

  13 DME suppliers used 280 Medicare Claims 1507 Services Paid

• DME-Other DME (DE001N)

  Pillow for use on nasal cannula type interface, replacement only, pair (HCPCS:A7033)

  11 DME suppliers used 120 Medicare Claims 585 Services Paid

• DME-Other DME (DE001N)

  Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap (HCPCS:A7034)

  19 DME suppliers used 420 Medicare Claims 420 Services Paid

• DME-Other DME (DE001N)

  Headgear used with positive airway pressure device (HCPCS:A7035)

  23 DME suppliers used 580 Medicare Claims 580 Services Paid

• DME-Other DME (DE001N)

  Chinstrap used with positive airway pressure device (HCPCS:A7036)

  7 DME suppliers used 34 Medicare Claims 34 Services Paid

• DME-Other DME (DE001N)

  Tubing used with positive airway pressure device (HCPCS:A7037)

  14 DME suppliers used 569 Medicare Claims 569 Services Paid

• DME-Other DME (DE001N)

  Filter, disposable, used with positive airway pressure device (HCPCS:A7038)

  25 DME suppliers used 829 Medicare Claims 4644 Services Paid

• DME-Other DME (DE001N)

  Filter, non disposable, used with positive airway pressure device (HCPCS:A7039)

  13 DME suppliers used 286 Medicare Claims 286 Services Paid

• DME-Other DME (DE001N)

  Water chamber for humidifier, used with positive airway pressure device, replacement, each (HCPCS:A7046)

  17 DME suppliers used 363 Medicare Claims 363 Services Paid

• DME-Oxygen and Supplies (DC000N)

  Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing (HCPCS:E0431)

  6 DME suppliers used 138 Medicare Claims 138 Services Paid

• DME-Other DME (DE005N)

  Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) (HCPCS:E0465)

  1 DME suppliers used 12 Medicare Claims 12 Services Paid

• DME-Other DME (DE005N)

  Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) (HCPCS:E0466)

  3 DME suppliers used 40 Medicare Claims 40 Services Paid

• DME-Other DME (DE001N)

  Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) (HCPCS:E0470)

  7 DME suppliers used 120 Medicare Claims 120 Services Paid

• DME-Other DME (DE001N)

  Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device) (HCPCS:E0471)

  3 DME suppliers used 18 Medicare Claims 18 Services Paid

• DME-Other DME (DE001N)

  Humidifier, heated, used with positive airway pressure device (HCPCS:E0562)

  7 DME suppliers used 36 Medicare Claims 36 Services Paid

• DME-Other DME (DE001N)

  Humidifier, heated, used with positive airway pressure device (HCPCS:E0562)

  8 DME suppliers used 420 Medicare Claims 420 Services Paid

• DME-Other DME (DE000N)

  Nebulizer, with compressor (HCPCS:E0570)

  3 DME suppliers used 102 Medicare Claims 102 Services Paid

• DME-Other DME (DE001N)

  Continuous positive airway pressure (cpap) device (HCPCS:E0601)

  16 DME suppliers used 1050 Medicare Claims 1050 Services Paid

• DME-Oxygen and Supplies (DC002N)

  Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate (HCPCS:E1390)

  10 DME suppliers used 342 Medicare Claims 342 Services Paid

• DME-Oxygen and Supplies (DC002N)

  Portable oxygen concentrator, rental (HCPCS:E1392)

  5 DME suppliers used 62 Medicare Claims 62 Services Paid

• DME-Oxygen and Supplies (DC000N)

  Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing (HCPCS:K0738)

  4 DME suppliers used 19 Medicare Claims 19 Services Paid

• DME-Other DME (DE000N)

  Pharmacy dispensing fee for inhalation drug(s); per 30 days (HCPCS:Q0513)

  22 DME suppliers used 120 Medicare Claims 120 Services Paid

• DME-Other DME (DE000N)

  Pharmacy dispensing fee for inhalation drug(s); per 90 days (HCPCS:Q0514)

  8 DME suppliers used 11 Medicare Claims 11 Services Paid

Orthotic Devices

• DME-Orthotic Devices (DF000N)

  Tracheostomy, inner cannula (HCPCS:A4623)

  1 DME suppliers used 12 Medicare Claims 345 Services Paid

• DME-Orthotic Devices (DF000N)

  Tracheostomy tube collar/holder, each (HCPCS:A7526)

  1 DME suppliers used 11 Medicare Claims 349 Services Paid

Drugs Administered Through DME

• DME-Drugs Administered Through DME (DG006N)

  Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg (HCPCS:J7613)

  6 DME suppliers used 14 Medicare Claims 4405 Services Paid

• DME-Drugs Administered Through DME (DG006N)

  Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme (HCPCS:J7620)

  20 DME suppliers used 106 Medicare Claims 14090 Services Paid

• DME-Drugs Administered Through DME (DG000N)

  Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg (HCPCS:J7626)

  10 DME suppliers used 56 Medicare Claims 3225 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.

Administration of chemotherapy into vein, 1 hour or less

Chemotherapy is a treatment that uses drugs to destroy cancer cells. When administered into a vein, it's often through an IV. This procedure usually lasts 1 hour or less. You may feel a slight pinch as the needle is inserted, but it's generally painless.

This service was performed 16 times for 13 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 12 times for 12 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 264 times for 244 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 35 times for 35 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 28 times for 28 patients

Sleep study in sleep lab (6 years or older)

A sleep study in a sleep lab is a non-invasive overnight test that monitors your body while you sleep. It helps doctors understand your sleep patterns and identify any issues like sleep apnea or insomnia. You'll be connected to equipment that tracks your heart rate, brain waves, breathing, and movements.

This service was performed 23 times for 23 patients

Sleep study in sleep lab (6 years or older)

A sleep study in a sleep lab is a non-invasive overnight test that monitors your body while you sleep. It helps doctors understand your sleep patterns and identify any issues like sleep apnea or insomnia. You'll be connected to equipment that tracks your heart rate, brain waves, breathing, and movements.

This service was performed 21 times for 21 patients

Sleep study in sleep lab with continuous airway pressure (6 years or older)

A sleep study in a sleep lab with continuous airway pressure is a test for individuals aged 6 and above. It monitors your sleep patterns to check for disorders like sleep apnea. Continuous airway pressure helps keep your airways open while you sleep, improving your breathing.

This service was performed 25 times for 25 patients

Sleep study in sleep lab with continuous airway pressure (6 years or older)

A sleep study in a sleep lab with continuous airway pressure is a test for individuals aged 6 and above. It monitors your sleep patterns to check for disorders like sleep apnea. Continuous airway pressure helps keep your airways open while you sleep, improving your breathing.

This service was performed 16 times for 16 patients

Test to determine lung volumes using sensors

This test, called spirometry, measures lung capacity using sensors. You breathe into a mouthpiece attached to a device that records the amount and rate of air you inhale and exhale. It helps diagnose and monitor lung conditions.

This service was performed 38 times for 38 patients

Test to examine how well the lungs exchange gases

This is a test called a pulmonary function test, which helps understand the efficiency of your lungs. It measures how much air your lungs can hold, how quickly you can move air in and out of your lungs, and how well your lungs put oxygen into and remove carbon dioxide from your blood.

This service was performed 38 times for 38 patients

Test to measure expiratory airflow and volume changes before and after medication administration

This procedure measures how air flows in and out of your lungs. It's done before and after medication to see if the treatment improves your breathing. It's a simple, non-invasive test that involves breathing into a device called a spirometer.

This service was performed 30 times for 30 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $30.92 for a new patient copayment and $23.85 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 53913 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.

Quality Reporting

The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.

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. James Sehloff is affiliated with the following medical facilities:

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