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NPI 1083871974 · Lombard, IL · Retina Specialist (Ophthalmology) Physician
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Brian Larsen is a retina specialist (ophthalmology) physician provider located in Lombard, Illinois. This profile covers 13 Medicare and 5 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Brian Larsen |
| Address | 477 E Butterfield Rd Ste 105 |
| City | Lombard |
| State | IL |
| ZIP | 60148 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | May 19, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.8M |
| Medicaid | $197.6K |
This provider’s volume is heavily Medicare-weighted: total Medicare revenue is $3.8M versus total Medicaid revenue of $197.6K, so Medicare represents the dominant payer by scale while Medicaid activity is comparatively modest. The practice therefore functions primarily within the Medicare market for its high-cost retinal services rather than as a Medicaid-focused provider.
Medicare revenue is highly concentrated: the precomputed top three Medicare codes account for 91.9% of this provider’s Medicare revenue, with J0178 alone contributing $3M (79.4% of Medicare revenue). That single-code concentration signals that aflibercept injections are the principal revenue driver on Medicare.
The code mix and volumes indicate an intravitreal-injection–centric retina practice: high Medicare counts for J0178 (4.4K claims), substantial procedural coding for 67028 (2.3K claims) and frequent retinal imaging with 92134 (3.2K claims). Combined with repeated comprehensive and follow-up exam codes such as 92014 (1.4K claims), the pattern is consistent with a retina specialist clinic focused on frequent injection visits plus diagnostic imaging and periodic exams.
On Medicare this provider is a clear high-volume national outlier for multiple retinal services: J0178 ranks #43 of 3204 providers (99th percentile; extreme outlier), 92134 ranks #339 of 26868 providers (99th percentile; extreme outlier), and 92014 ranks #717 of 35415 providers (98th percentile; extreme outlier). These rank/percentile signals indicate the provider operates at a much higher national volume for these codes than most peers, establishing a strong national competitive standing in injection and imaging services.
By contrast, Medicaid activity is both concentrated and relatively typical in-state: the precomputed top three Medicaid codes account for 94.1% of Medicaid revenue, led by J0178 ($94.1K, 47.7%) and 67028 ($77.5K, 39.3%). However, in-state ranks for those codes are not dominant—J0178 ranks #30 of 45 in-state (34th percentile) and 67028 ranks #58 of 120 in-state (52nd percentile)—indicating the provider is a routine, not leading, Medicaid participant for these services.
Operational differences between payers are visible in unit economics and claim counts: Medicare shows 4.4K claims for J0178 at an average paid/claim of $693, whereas Medicaid shows 112 claims for J0178 at an average paid/claim of $840. This juxtaposition highlights that the provider’s Medicare practice drives scale while Medicaid involves fewer claims but differing per-claim payments, which could affect payer negotiation or utilization management strategies differently by program.
The provider’s national and state-level competitiveness is mixed: nationally the provider is an extreme outlier on several Medicare retinal codes (establishing a high-volume specialist profile), while its Medicaid rankings are largely typical for the state. Analysts should treat this entity as a major Medicare retina injection and imaging source but a modest Medicaid participant when modeling network capacity or regional service availability.
The NPI tenure supports an established practice footprint: enumerated on 2008-05-19 (~18 years ago), the provider appears to have sustained operations long enough to build concentrated service lines and high Medicare volumes. That longevity, combined with the heavy reliance on a small number of codes, suggests stable specialization rather than a transient billing pattern.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
13 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4,390 | $690 | $3M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 8,760 | $30 | $254K |
| 67028 | The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye. | 2,270 | $100 | $222.1K |
| 92014 | An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group… | 1,420 | $90 | $129K |
| 92134 | The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes. | 3,160 | $30 | $98.1K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 280 | $160 | $44.2K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 170 | $110 | $19.1K |
| J9035 | Injection, bevacizumab, 10 mg | 280 | $60 | $15.6K |
| 92235 | The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken… | 20 | $100 | $1.7K |
| 92250 | Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,… | 40 | $30 | $940 |
Showing 1–10 of 13
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
13 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 2 | 140 | 700 | $690 | $688.4K |
| J2777 | 45 | 90 | 9,180 | $30 | $451K |
| 67028 | 9 | 190 | 400 | $90 | $64.4K |
| J7312 | 12 | 30 | 240 | $160 | $45.1K |
| 92014 | 48 | 1,420 | 130 | $80 | $24.7K |
| J9035 | 44 | 130 | 140 | $60 | $24.6K |
| 99214 | 18,031 | 18,540 | 110 | $80 | $17.1K |
| 92012 | 650 | 670 | 100 | $60 | $12.4K |
| 92134 | 13 | 1,080 | 80 | $30 | $9K |
| 92235 | 61 | 90 | 30 | $100 | $8.3K |
Showing 1–10 of 13
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
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Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 110 | $840 | $94.1K |
| 67028 | The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye. | 570 | $140 | $77.5K |
| 92134 | The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes. | 1,260 | $10 | $13.9K |
| 92014 | An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group… | 670 | $20 | $11.3K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 10 | $30 | $320 |
How this provider's Medicaid billing volume and revenue compare to other Illinois providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Illinois median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 30 | 50 | 200 | $1,100 | $391.2K |
| 67028 | The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye. | 58 | 120 | 540 | $160 | $166.3K |
| 92014 | An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group… | 521 | 1,230 | 450 | $40 | $54.1K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 1,080 | 1,110 | 310 | $50 | $45.3K |
| 92134 | The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes. | 76 | 250 | 510 | $20 | $20.1K |
Other providers in the same ZIP code as Brian Larsen, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Intelliride, LLC | IL | Transportation Broker | $0 | $297.1M |
| United Seating And Mobility LLC | IL | Durable Medical Equipment & Medical Supplies | $0 | $28.7M |
| Health Resources Solutions Inc | IL | Home Health Agency | $0 | $21.8M |
| Us Spa Corp | IL | Clinical Medical Laboratory | $20.4M | $384.3K |
| U & F Sons, Inc. | IL | Homemaker | $0 | $15.6M |
| Us Medical Labs Inc | IL | Clinical Medical Laboratory | $603.4K | $12.5M |
| Mmm Diagnostic Center Inc | IL | Clinical Medical Laboratory | $939.6K | $10.9M |
| United Eg LLC | IL | Clinical Medical Laboratory | $227.3K | $11.1M |
| Kevin Mccune | IL | Family Medicine Physician | $0 | $9.6M |
| Village Of Lombard | IL | Land Ambulance | $552.9K | $6.7M |
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