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NPI 1093820953 · Owensboro, KY · Interventional Cardiology Physician
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Roshan Mathew is a interventional cardiology physician provider located in Owensboro, Kentucky. This profile covers 47 Medicare and 7 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 | Roshan Mathew |
| Address | 3110 Fairview Dr |
| City | Owensboro |
| State | KY |
| ZIP | 42303 |
| Taxonomy | Interventional Cardiology Physician |
| NPI Enumerated | August 20, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1M |
| Medicaid | $0 |
Revenue concentration is high: the provider's top three Medicare codes (99214, 93306, 78452) account for 59.8% of total Medicare revenue, with 99214 generating $300.2K (29.9%), 93306 $156.5K (15.6%), and 78452 $143.3K (14.3%). This level of concentration indicates the practice’s financial performance is driven primarily by office-based E/M and cardiac diagnostic imaging services.
The code mix points to an outpatient cardiology operation focused on diagnostic imaging and stress testing rather than procedural interventional work: high revenues for 93306 (echocardiography), 78452 (cardiac SPECT), and supporting items like J2785 (regadenoson, $78.4K) and A9500 (technetium, $44K) show heavy throughput of imaging and pharmacologic stress studies. Presence of E/M codes such as 99214 and device-management codes (e.g., 93280) further suggests ongoing clinic follow-up and device care as core service lines.
On competitive standing, this provider is a national high-volume outlier for multiple core codes: 99214 ranks #129 of 479517 providers (100th percentile; extreme outlier), 93306 ranks #140 of 24624 (99th percentile; extreme outlier), and 78452 ranks #113 of 14946 (99th percentile; extreme outlier). Those ranks indicate the provider bills far above typical national volumes for office E/M and cardiac imaging, consistent with a dominant local referral footprint for these services.
Beyond the top three, other services also show unusually high volume relative to peers: 93793 (INR management) has 2.3K claims and $18.7K revenue and ranks #34 of 4137 (99th percentile; extreme outlier), while 93000 (ECG) has 1.8K claims and $17.8K revenue and ranks #236 of 71016 (100th percentile; extreme outlier). This combination of high-volume INR monitoring, ECG, and device follow-up (93280) indicates the practice manages a substantial panel of chronic cardiovascular patients and implanted-device follow-up.
Medicaid exposure is effectively nil: lifetime Medicare revenue is $1M while lifetime Medicaid revenue is $0, so the provider operates as essentially single-payer (Medicare) in the claims on file. This concentration on Medicare revenue reduces diversification by payer and concentrates reimbursement risk and policy exposure on Medicare payment changes.
The provider has long tenure in the Medicare program, with an NPI enumerated 2006-08-20 (~20 years ago), suggesting an established practice and likely sustained referral relationships that could explain persistent high volumes in imaging and E/M codes. Longevity combined with extreme-volume rankings supports the interpretation of a stable, referral-driven outpatient cardiology practice.
Hospital-based care appears to be a meaningful adjunct to the outpatient practice: 99232 (subsequent hospital care) produced $47.8K (4.8%) and ranks #7050 of 177383 (96th percentile; notably above typical volume), and 99223 (initial hospital care) produced $28.1K (2.8%) and ranks #7355 of 139583 (95th percentile; notably above typical volume). These inpatient E/M volumes indicate the provider is also engaged in hospital consults or inpatient cardiology services in addition to outpatient imaging and follow-up.
Operational and margin implications flow from the revenue mix: large shares from imaging and stress testing (including paid items like J2785 and A9500) imply significant supply and imaging infrastructure utilization, while high volumes of 99214 visits and device-management codes suggest staffing and clinic capacity are key drivers. Payer concentration in Medicare plus reliance on high-volume diagnostic studies should be considered when assessing reimbursement vulnerability and capital needs for imaging/device-support equipment.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
47 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 3,530 | $90 | $300.2K |
| 93306 | The provider uses transducers to obtain two–dimensional (2D) images of the heart structures through the chest wall. He evaluates the anatomy and function of all four heart chambers, valves, adjacent… | 1,280 | $120 | $156.5K |
| 78452 | In this procedure, the provider performs multiple SPECT studies of the heart to determine the areas of deficient blood flow. The goal of the procedure is to determine areas that have deficient blood… | 480 | $300 | $143.3K |
| J2785 | Injection, regadenoson, 0.1 mg | 1,780 | $40 | $78.4K |
| 99232 | The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or… | 780 | $60 | $47.8K |
| A9500 | Technetium tc-99m sestamibi, diagnostic, per study dose | 900 | $50 | $44K |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 580 | $60 | $32.4K |
| 99223 | The provider sees a patient for an initial hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the… | 210 | $130 | $28.1K |
| 93015 | The provider supervises the recording of the electrical activity of the heart to examine any abnormality in its functioning by obtaining blood pressure and electrocardiograph readings at regular… | 470 | $50 | $21.4K |
| 93880 | Duplex scanning of arteries for the evaluation of blood flow is a type of non–invasive vascular diagnostic process. A physician can visualize and selectively assess the flow patterns of peripheral… | 160 | $130 | $19.6K |
Showing 1–10 of 47
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 47 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
47 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 93306 | 1 | 330 | 240 | $60 | $16K |
| J2785 | 1 | 30 | 250 | $40 | $14.6K |
| 99214 | 1 | 7,230 | 110 | $70 | $14.1K |
| 99232 | 104 | 2,860 | 100 | $60 | $11.6K |
| G2066 | 39 | 50 | 120 | $50 | $9.8K |
| 93458 | 108 | 130 | 50 | $190 | $9.6K |
| 99223 | 97 | 1,940 | 40 | $130 | $8.6K |
| A9500 | 1 | 10 | 120 | $40 | $8K |
| 78452 | 1 | 230 | 70 | $90 | $7.7K |
| 99213 | 268 | 7,250 | 80 | $50 | $7.7K |
Showing 1–10 of 47
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 1036F | N/A | 20 | $0 | $0 |
| 1123F | No Summary found for this code | 20 | $0 | $0 |
| G8417 | Bmi is documented above normal parameters and a follow-up plan is documented | 20 | $0 | $0 |
| G8427 | Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications | 20 | $0 | $0 |
| G8598 | Aspirin or another antiplatelet therapy used | 20 | $0 | $0 |
| G8752 | Most recent systolic blood pressure < 140 mmhg | 20 | $0 | $0 |
| G8754 | Most recent diastolic blood pressure < 90 mmhg | 20 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky median
7 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| G8427 | Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications | 252 | 280 | 340 | $1 | $60 |
| G8417 | Bmi is documented above normal parameters and a follow-up plan is documented | 133 | 150 | 260 | $1 | $40 |
| 1036F | N/A | 225 | 240 | 680 | $1 | $10 |
| G8598 | Aspirin or another antiplatelet therapy used | 13 | 10 | 60 | $1 | $1 |
| G8752 | Most recent systolic blood pressure < 140 mmhg | 81 | 90 | 250 | $1 | $1 |
| G8754 | Most recent diastolic blood pressure < 90 mmhg | 87 | 100 | 280 | $1 | $1 |
| 1123F | No Summary found for this code | 22 | 30 | 50 | $0 | $0 |
Other providers in the same ZIP code as Roshan Mathew, ranked by combined Medicare and Medicaid revenue.
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