This provider averages 55 services per working day
Based on 123.2K total services over 9 years (250 working days/year). Learn about impossible service volumes →
This provider's $20.0M in total Medicare payments ranks in the 99th percentile of Ophthalmology providers nationally.
Averaging 55 services per working day raises questions about billing patterns.
Medicare payments to this provider grew 11327% from 2015 to 2023.
60% of their billing comes from a single procedure code (J0178 — Injection, aflibercept, 1 mg).
AI-generated analysis based on Medicare payment data.
Notable: Payments increased 1281% in 2018
Year-over-year payment surges can indicate changes in practice volume, new services, or billing pattern shifts.
Average per-service amounts submitted by the provider compared to what Medicare actually paid — the gap represents the markup.
| Year | Avg Submitted | Avg Paid | Markup Ratio | Gap per Service | Total Payments | Services | Beneficiaries |
|---|---|---|---|---|---|---|---|
| 2015 | $185.88 | $63.92 | 2.91x | $121.96 | $35.8K | 560 | 8 |
| 2016 | $456.05 | $133.94 | 3.40x | $322.11 | $116.7K | 871 | 15 |
| 2017 | $266.50 | $119.19 | 2.24x | $147.31 | $143.3K | 1.2K | 16 |
| 2018 | $257.00 | $146.48 | 1.75x | $110.52 | $2.0M | 13.5K | 18 |
| 2019 | $309.55 | $181.97 | 1.70x | $127.58 | $3.1M | 17.1K | 19 |
| 2020 | $414.82 | $226.71 | 1.83x | $188.11 | $3.3M | 14.5K | 20 |
| 2021 | $557.49 | $223.25 | 2.50x | $334.24 | $3.7M | 16.6K | 17 |
| 2022 | $634.46 | $191.83 | 3.31x | $442.63 | $3.6M | 18.7K | 17 |
| 2023 | $430.39 | $101.67 | 4.23x | $328.72 | $4.1M | 40.2K | 22 |
| Code | Description | Services | Payments | Avg/Service | Markup |
|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 16.5K | $11.9M | $723.65 | 2.13x |
| J2778 | Injection, ranibizumab, 0.1 mg | 8.5K | $2.1M | $245.02 | 2.66x |
| 92014 | Established patient complete exam of visual system | 13.6K | $1.4M | $101.65 | 2.27x |
| 67028 | Injection of drug into eye | 10.7K | $1.1M | $101.47 | 5.64x |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 25.6K | $747.9K | $29.19 | 4.28x |
| 92134 | Imaging of retina | 20.4K | $705.6K | $34.55 | 5.79x |
| J3490 | Unclassified drugs | 177 | $327.0K | $1.8K | 3.10x |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 1.7K | $272.8K | $158.39 | 2.46x |
| J3590 | Unclassified biologics | 78 | $195.4K | $2.5K | 3.09x |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 1.6K | $157.8K | $97.18 | 2.05x |
| 92226 | Examination of eye by ophthalmoscope with retinal drawing | 6.4K | $141.2K | $21.94 | 2.16x |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 1.1K | $130.0K | $120.36 | 3.05x |
| J9035 | Injection, bevacizumab, 10 mg | 1.7K | $100.9K | $59.89 | 2.73x |
| 92004 | New patient complete exam of visual system | 820 | $92.4K | $112.71 | 2.38x |
| 92202 | Extended exam of the back part of the eye with optic nerve drawing | 6.9K | $91.5K | $13.27 | 6.29x |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 697 | $88.7K | $127.25 | 1.97x |
| 67108 | Repair of detached retina and drainage of eye fluid between lens and retina | 136 | $86.3K | $634.84 | 2.84x |
| 67145 | Photocoagulation treatment to prevent detachment of retina | 194 | $74.7K | $385.00 | 3.59x |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 295 | $63.3K | $214.74 | 4.66x |
| 92201 | Extended exam of the back part of the eye with retinal drawing | 2.0K | $39.9K | $20.23 | 4.33x |
This provider submits charges 2.69 times higher than what Medicare actually pays.
A markup ratio of 2.69x means for every $100 Medicare pays, this provider initially charges $269. This is higher than the national average.
Always verify provider credentials and location before scheduling appointments. This data reflects Medicare payments and may not include all practice locations.
Other Ophthalmology providers in VA for peer comparison.
| Provider | Location | Total Payments | Status |
|---|---|---|---|
| Timothy Byrnes, MD | Roanoke, VA | $53.3M | ✓ Clear |
| James Tiedeman | Fishersville, VA | $51.1M | ✓ Clear |
| Juan Astruc, M.D. | Richmond, VA | $46.6M | ✓ Clear |
| Kapil Kapoor, MD | Norfolk, VA | $43.0M | ✓ Clear |
| Alan Wagner, MD | Norfolk, VA | $42.8M | ✓ Clear |
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Last Updated: February 2026 (data through 2023, the latest CMS release)
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.
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