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NPI 1093906281 · Norfolk, VA · Ophthalmology Physician
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Kapil Kapoor is a ophthalmology physician provider located in Norfolk, Virginia. This profile covers 21 Medicare and 1 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 | Kapil Kapoor |
| Address | 6160 Kempsville Cir Ste 120b |
| City | Norfolk |
| State | VA |
| ZIP | 23502 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | August 5, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.6M |
| Medicaid | $420 |
Practice is overwhelmingly Medicare-facing: lifetime Medicare revenue is $3.6M versus total Medicaid revenue reported as $417, so the provider operates with a Medicare-dominated payer mix and effectively negligible Medicaid volume. This skew means analyses of utilization, revenue risk, and network value should be driven by Medicare activity rather than Medicaid activity.
Revenue is highly concentrated in a small set of services: the precomputed top 3 Medicare codes account for 77.0% of the provider's Medicare revenue, driven by J0178 ($1.8M), J2777 ($516.8K), and 92014 ($422.1K). On the Medicaid side the top codes account for 100.0% of Medicaid revenue, with 92134 listed as the sole Medicaid revenue source ($420).
Clinical mix and service-line implication: the Medicare code mix is consistent with a retina-focused ophthalmology practice that delivers high-volume intravitreal pharmacologic therapy (J0178, J2777, J9035) alongside comprehensive ophthalmology visits (92014) and retinal procedures (67028). Significant utilization of retinal imaging (92134) and intravitreal injection codes indicates the provider’s operations center on medical retina care and procedure-based office treatments rather than broad inpatient or multispecialty services.
Mixed competitive standing across codes: the provider is an extreme national outlier for several retinal diagnostics and procedure codes—92014 ranks #8 of 35415 (100th percentile; extreme outlier, far above typical national volume), 92134 ranks #43 of 26868 (100th percentile; extreme outlier, far above typical national volume), and J9035 ranks #9 of 1852 (100th percentile; extreme outlier, far above typical national volume)—suggesting unusually high throughput for these services. By contrast, the single largest Medicare revenue driver J0178 ranks #268 of 3204 (92th percentile; typical, unremarkable volume for this code), so high dollar concentration does not always align with atypical national volume for every top code.
Procedural/surgical footprint: the provider reports substantial revenue from intravitreal injection procedures and related retinal operations—67028 accounts for $316.4K and ranks #76 of 4255 (98th percentile; notably above typical national volume), while other surgical entries such as 67042 and 67036 are present but at much lower revenue. This mix indicates the practice performs both high-frequency office-based injection therapy and some higher-acuity vitreoretinal procedures, supporting a combined clinic-and-OR service model.
Small but measurable diagnostic imaging volume supports the clinical model: 92134 appears among the top Medicare items (5.1K claims, $159.3K) and is also the only Medicaid-coded service (15 claims, $420), reinforcing that retinal imaging is a routine part of the provider’s care pathway. The imaging codes’ national rankings (92134 Medicare: #43 of 26868, 100th percentile; Medicaid: #61 of 65, 5th percentile) underscore strong Medicare-driven imaging volume with minimal in-state Medicaid activity.
Data tenure and market presence: NPI enumerated 2007-08-05 (~19 years ago) indicates a long-established billing profile and likely an established referral and patient base, which is consistent with the high-volume, repeat-procedure nature of intravitreal therapy and ongoing retinal follow-up reflected in the E/M and imaging volumes. Longevity combined with extreme outlier status on several retina codes suggests an entrenched specialty practice rather than a recent or transient entrant.
Payer and utilization implications for analysts: because 77.0% of Medicare revenue is concentrated in three codes and injections/imaging dominate the mix, payers analyzing utilization or negotiating value-based arrangements should focus on intravitreal drug utilization patterns and retinal imaging/E&M intensity. The negligible Medicaid revenue (total $417 listed vs. 92134 at $420) means Medicaid-level contracting or utilization reviews are unlikely to materially affect overall revenue exposure, but analysts should note the small Medicaid footprint and the apparent rounding/inconsistency between the two Medicaid figures when reconciling records.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
21 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,640 | $680 | $1.8M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 17,820 | $30 | $516.8K |
| 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… | 4,800 | $90 | $422.1K |
| 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. | 3,230 | $100 | $316.4K |
| 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. | 5,140 | $30 | $159.3K |
| J9035 | Injection, bevacizumab, 10 mg | 2,480 | $60 | $139K |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 360 | $240 | $87.1K |
| 67042 | In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina… | 50 | $880 | $44.9K |
| 99204 | The provider sees a new 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 provider… | 260 | $110 | $29K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 100 | $140 | $13.3K |
Showing 1–10 of 21
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 21 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
21 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 19 | 80 | 1,400 | $690 | $1.1M |
| J2777 | 24 | 60 | 13,200 | $30 | $517.1K |
| 67028 | 2 | 90 | 1,000 | $90 | $107.1K |
| J0179 | 2 | 10 | 230 | $240 | $54.7K |
| J7312 | 21 | 20 | 240 | $160 | $42.5K |
| 67042 | 4 | 20 | 20 | $1,130 | $33.8K |
| 92014 | 2 | 870 | 170 | $80 | $32.8K |
| 99214 | 11,714 | 12,890 | 140 | $80 | $21K |
| J9035 | 2 | 60 | 170 | $50 | $19.9K |
| 67036 | 8 | 20 | 20 | $940 | $19.8K |
Showing 1–10 of 21
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.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | 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. | 20 | $30 | $420 |
How this provider's Medicaid billing volume and revenue compare to other Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Virginia median
1 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. | 61 | 70 | 210 | $20 | $47.3K |
Other providers in the same ZIP code as Kapil Kapoor, ranked by combined Medicare and Medicaid revenue.
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