DR. MICHAEL FAGIEN M.D.
NPI 1780680751
Radiology - Diagnostic Radiology in Hialeah, FL

Medicare Participation & PECOS Enrollment Status

Michael Fagien 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 Fagien 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: 9133028269

  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: I20040107000653

  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.

Ct scan head or brain without contrast

A CT scan of the head or brain without contrast is a non-invasive imaging procedure. It uses X-rays to create detailed pictures of your brain, skull, and other structures inside your head. It helps to detect conditions like strokes, tumors, or injuries. No dye (contrast) is used in this test.

This service was performed 15 times for 14 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 52 times for 52 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 60 times for 57 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 68 times for 67 patients

Ct scan of chest with contrast

A CT scan of the chest with contrast is an imaging procedure. A special dye (contrast) is used to highlight specific areas in your body, providing clearer pictures of your chest. This helps in diagnosing conditions related to your lungs, heart, and other chest structures.

This service was performed 30 times for 30 patients

Ct scan of chest without contrast

A CT scan of the chest without contrast is a non-invasive imaging procedure. It uses special X-ray equipment to produce detailed images of your chest area, including your lungs and heart. It can help diagnose conditions such as lung diseases or heart disorders. It doesn't involve any dyes or contrast agents.

This service was performed 75 times for 74 patients

Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries

Fluorodeoxyglucose F-18 FDG is a radioactive drug used in PET scans. It helps doctors see how your tissues and organs are functioning. The drug is given in a specific dose, up to 45 millicuries, depending on your body size and the type of scan.

This service was performed 434 times for 331 patients

Injection, regadenoson, 0.1 mg

Regadenoson injection, 0.1 mg, is a medication used to help visualize the heart during a stress test. It works by increasing blood flow in the arteries of the heart. It's injected into a vein and is generally well-tolerated.

This service was performed 424 times for 106 patients

Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries

Iodine 1-123 Ioflupane is a diagnostic procedure where a small radioactive substance is introduced into your body. It helps to create clear images of your brain, specifically to study the functioning of your brain's nerve cells.

This service was performed 14 times for 14 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 12,075 times for 134 patients

Nuclear medicine studies of blood flow in heart muscle at rest and with stress with concurrent ct scan

This is a diagnostic test where a tiny amount of radioactive material is used to examine your heart's blood flow at rest & during stress, alongside a CT scan for detailed images. It helps identify any heart-related issues like blockages or damage.

This service was performed 29 times for 29 patients

Nuclear medicine studies of heart muscle at rest and with stress and spect

Nuclear medicine studies of the heart involve two parts: rest and stress. During rest, images are taken of your heart at ease. During stress, images are taken after exercise or medication-induced stress. SPECT is a special imaging technique providing 3D pictures of your heart, helping identify any issues.

This service was performed 147 times for 147 patients

Nuclear medicine study from skull base to mid-thigh with ct scan

A nuclear medicine study from skull base to mid-thigh with a CT scan involves using a small amount of radioactive material and CT imaging to examine body tissues and organs. This helps detect any abnormalities by providing detailed images of the body's internal structure.

This service was performed 387 times for 291 patients

Nuclear medicine study of bone and/or joint whole body

A nuclear medicine study of bone and/or joint whole body involves injecting a small amount of radioactive material into your body. This material travels to your bones and emits energy. A special camera captures this energy, creating images of your bones to help identify any abnormalities.

This service was performed 95 times for 92 patients

Nuclear medicine study of stomach to assess emptying

A nuclear medicine study of the stomach assesses how quickly food leaves the stomach. A safe, radioactive substance is added to a meal. The radiation emitted is tracked, creating images that show the food's progress through the stomach. It's non-invasive and painless.

This service was performed 14 times for 14 patients

Nuclear medicine study of thyroid and thyroid function

A nuclear medicine study of the thyroid involves using a small amount of radioactive material to evaluate thyroid function. It helps identify issues such as overactive or underactive thyroid. The procedure is safe and provides valuable information about your thyroid health.

This service was performed 12 times for 12 patients

Nuclear medicine study whole body with ct scan

A Nuclear Medicine Study with a CT Scan is a diagnostic procedure. It uses a small amount of radioactive substance and a CT scan to create detailed images of your body. These images help doctors diagnose, monitor, and treat various conditions.

This service was performed 44 times for 39 patients

Nuclear medicine study, 1 area with spect

A nuclear medicine study with SPECT involves a safe, small amount of radioactive substance to help visualize body organs. SPECT, or Single Photon Emission Computed Tomography, creates detailed 3D images. This helps doctors diagnose and monitor conditions in a specific body area.

This service was performed 15 times for 15 patients

Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries

Rubidium Rb-82 is a radioactive drug used in a PET scan to help visualize the heart. It helps detect areas with poor blood flow, aiding in diagnosing heart conditions. The dose is up to 60 millicuries per study.

This service was performed 58 times for 29 patients

Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries

Technetium Tc-99m Medronate is a diagnostic procedure that uses a small amount of radioactive material to examine the health of your bones. It helps to detect bone diseases or abnormalities. The procedure is safe, with the radioactive substance naturally leaving your body after the test.

This service was performed 88 times for 86 patients

Technetium tc-99m sestamibi, diagnostic, per study dose

Technetium Tc-99m Sestamibi is a diagnostic test used to create images of your heart or breast tissues. It involves a safe radioactive substance injection that helps doctors to detect any abnormalities or changes in these tissues.

This service was performed 296 times for 151 patients

Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries

Technetium Tc-99m sulfur colloid is used in diagnostic imaging tests. It helps to highlight areas of concern in the body by emitting a small amount of radiation that can be detected by a special camera. This helps doctors to diagnose and monitor various health conditions.

This service was performed 14 times for 14 patients

Physician Visit Costs

The typical physician office visit costs for Medicare beneficiaries in this area are: $24.03 for a new patient copayment and $18.96 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 33012 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 68.2, 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: 68.2 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: 33.33

  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: 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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