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NPI 1093824179 · Great Falls, MT · Ophthalmology Physician
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Thomas Matsko is a ophthalmology physician provider located in Great Falls, Montana. This profile covers 11 Medicare and 2 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 | Thomas Matsko |
| Address | 2800 11th Ave S |
| City | Great Falls |
| State | MT |
| ZIP | 59405 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | August 30, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $684.5K |
| Medicaid | $147.1K |
This provider bills materially more to Medicare than to Medicaid, with Total Medicare revenue of $684.5K versus Total Medicaid revenue of $147.1K; Medicare is clearly the dominant payer by scale for this practice. The NPI was enumerated on 2006-08-30 (~20 years ago), indicating a long-tenured presence in the market that aligns with sustained billing across both programs.
Medicare revenue is highly concentrated in a small set of services: the precomputed top 3 Medicare codes account for 89.7% of this provider's total Medicare revenue. Those top drivers are J0178 (662 claims, $693 avg paid/claim, $458.8K revenue, 67.0% of Medicare revenue), 92012 (1.7K claims, $61 avg paid/claim, $105.8K revenue, 15.5%), and 92134 (1.8K claims, $28 avg paid/claim, $49.4K revenue, 7.2%), which together define the primary revenue stream.
Medicaid billing is even more concentrated: the precomputed top 3 Medicaid codes account for 100.0% of this provider's total Medicaid revenue, and commercial activity is dominated by routine visits and retinal imaging. On Medicaid the two listed drivers are 92012 (2.5K claims, $42 avg paid/claim, $104.4K revenue, 70.6% of Medicaid revenue) and 92134 (2.3K claims, $19 avg paid/claim, $43.5K revenue, 29.4%), showing almost all Medicaid dollars come from intermediate eye exams and posterior segment imaging.
The mix of top Medicare codes — J0178 (injection, aflibercept), 92012 (established intermediate eye exam), and 92134 (retinal imaging) — indicates a practice structured around medical retinal care and repeat visit management. High-volume, procedure-driven billing for J0178 together with heavy use of 92134 suggests an operational model that supports an injection clinic workflow with frequent follow-up imaging and established-patient visits.
Competitive standing is mixed across payers and codes: for Medicare this provider is an extreme outlier on 92012 (rank #118 of 17177, 99th percentile), and notably above typical on 92134 (rank #1263 of 26868, 95th percentile), signaling unusually high national volume of intermediate exams and retinal imaging. By contrast, the largest Medicare revenue source J0178 ranks #1685 of 3204 (47th percentile), a typical national volume for aflibercept injections despite its outsized contribution to this provider's Medicare revenue.
In-state competitive positioning on Medicaid shows the provider ranks among the higher-volume peers for core ophthalmology services but not as an extreme outlier: 92012 is ranked #5 of 33 in-state (88th percentile) and 92134 is ranked #5 of 16 in-state (73th percentile). Those placements imply the provider is a meaningful regional source of routine ophthalmic care and imaging in Montana, capturing substantial state Medicaid activity for office-based eye care.
Operationally, the billing profile—large counts of 92012 and 92134 across both payers plus dominant Medicare revenue from J0178—is consistent with management of chronic retinal conditions (for example neovascular disease) that require recurring intravitreal injections and serial OCT/retinal imaging. This blend of high follow-up visit volume and procedure-based revenue suggests the practice’s capacity and scheduling are adapted to frequent-return patients and procedure throughput rather than episodic surgical volume.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
11 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 660 | $690 | $458.8K |
| 92012 | For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any… | 1,730 | $60 | $105.8K |
| 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. | 1,760 | $30 | $49.4K |
| 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. | 390 | $80 | $30.8K |
| 67108 | The provider repairs a detached retina using heat produced by a laser beam or by freezing the tissues. He may attach a scleral buckle to simplify the passage of fluid through and behind the retina or… | 10 | $900 | $11.8K |
| 67041 | In this procedure, the provider removes scar tissue from the retinal membrane that obscures vision. He removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical… | 10 | $800 | $11.2K |
| 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… | 90 | $80 | $6.8K |
| 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. | 50 | $100 | $5.6K |
| J9035 | Injection, bevacizumab, 10 mg | 40 | $60 | $2.1K |
| 76512 | The provider uses B–scan ultrasound imaging, with or without a non–qualitative A–scan superimposed, to examine the intraocular and orbital structures. | 40 | $40 | $1.5K |
Showing 1–10 of 11
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 11 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 92012 | For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any… | 2,490 | $40 | $104.4K |
| 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. | 2,290 | $20 | $43.5K |
How this provider's Medicaid billing volume and revenue compare to other Montana providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Montana median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 5 | 20 | 1,300 | $20 | $28.6K |
| 92012 | For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any… | 5 | 30 | 270 | $10 | $12.6K |
Other providers in the same ZIP code as Thomas Matsko, ranked by combined Medicare and Medicaid revenue.
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