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NPI 1114260163 · Hagerstown, MD · Ophthalmology Physician
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Jay Berdia is a ophthalmology physician provider located in Hagerstown, Maryland. 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 | Jay Berdia |
| Address | 1800 Dual Highway |
| City | Hagerstown |
| State | MD |
| ZIP | 21740 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | March 28, 2013 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.5M |
| Medicaid | $680 |
Practice profile and service mix indicate a retina-focused ophthalmology operation: the top Medicare revenue drivers are intravitreal drug administration and high-acuity ophthalmic testing, led by Q5124 ($773.2K, 30.2% of Medicare revenue) and J2777 ($675.1K, 26.4%). High volumes of diagnostic imaging codes such as 92134 (2.1K claims, $61.5K) and 76512 (417 claims, $14.2K) further support a clinical emphasis on retinal disease management and procedural injection visits rather than broad primary eye care.
Medicare revenue is the dominant payer for this NPI: lifetime Medicare revenue is $2.5M compared with lifetime Medicaid revenue of $678, indicating an effectively Medicare-centric practice footprint. The platform data also show 92134 listed under Medicaid as $682 (100.0% of Medicaid revenue), which underscores that any Medicaid activity is minimal relative to Medicare.
Revenue concentration on Medicare is high: the precomputed top-three Medicare codes account for 66.2% of the provider’s total Medicare revenue, with Q5124, J2777, and J3490 together representing the bulk of billings. That concentration suggests the business depends heavily on a small set of high-revenue biologic/drug administrations rather than a broadly diversified set of office or surgical services.
Competitive standing by code is mixed: this provider is a national top-tier performer for Q5124 (ranks #3 of 122 nationally, 98th percentile), indicating unusually strong billing for that specific ranibizumab biosimilar. By contrast, J2777 and J3490 are in more typical national volume ranges (79th and 80th percentiles respectively), so dominance is concentrated on a single code rather than across all intravitreal drugs.
Several non-drug services are reported at notably above-typical national volumes, highlighting diagnostic intensity: 99214 ranks #18862 of 479517 (96th percentile), 92134 ranks #928 of 26868 (97th percentile), and 76512 ranks #65 of 2292 (97th percentile). These elevated percentiles for evaluation-and-management and retinal imaging codes align with a high-touch, procedure-driven retina practice that pairs injections with frequent diagnostic follow-up.
There are both high-cost single-claim items and high-volume low-unit items in the Medicare mix: J3490 shows a high average paid per claim ($1909 avg paid/claim, $244.4K revenue) while J2403 appears as very high claim volume at a low unit price (178.4K claims, $1 avg paid/claim, $178.4K revenue). This combination suggests the practice bills for both expensive unclassified drug administrations and large-volume, low-reimbursement ophthalmic supply items or formulations.
Medicaid footprint is minimal and not a competitive strength in-state: Medicaid revenue is effectively negligible ($678 lifetime), and the Medicaid 92134 activity (31 claims, $682 reported for the code) ranks #66 of 81 providers in-state (19th percentile), indicating below-average Medicaid engagement for retinal imaging among Maryland peers. Operationally, this implies limited reliance on state plan volumes and potential sensitivity to Medicare reimbursement trends.
Provider tenure is established but not long-tenured by historic standards: the NPI was enumerated 2013-03-28 (~13 years ago), which corresponds with a decade-plus billing history that is sufficient to generate the observed concentrated Medicare revenue patterns and the distinct code-level competitive footprints described above.
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 |
|---|---|---|---|---|
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 4,580 | $170 | $773.2K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 23,280 | $30 | $675.1K |
| J3490 | Unclassified drugs | 130 | $1,910 | $244.4K |
| J2403 | Chloroprocaine hcl ophthalmic, 3% gel, 1 mg | 178,400 | $1 | $178.4K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 1,340 | $120 | $160.2K |
| 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. | 1,380 | $90 | $124.2K |
| J0178 | Injection, aflibercept, 1 mg | 160 | $680 | $107.6K |
| 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… | 810 | $90 | $73.1K |
| 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. | 2,120 | $30 | $61.5K |
| 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… | 290 | $110 | $30.4K |
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 |
|---|---|---|---|---|---|
| Q5124 | 1 | 10 | 17,150 | $170 | $2.6M |
| J0178 | 85 | 100 | 950 | $690 | $887.3K |
| J2403 | 1 | 10 | 860,000 | $1 | $506.2K |
| J2777 | 20 | 70 | 8,520 | $30 | $487.3K |
| J2781 | 1 | 20 | 620 | $120 | $258.6K |
| J2778 | 46 | 50 | 650 | $180 | $207.8K |
| 67028 | 33 | 120 | 700 | $100 | $101.5K |
| 92242 | 1 | 10 | 210 | $210 | $63.4K |
| J3490 | 3 | 100 | 70 | $450 | $62.1K |
| 92014 | 589 | 620 | 210 | $90 | $44K |
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. | 30 | $20 | $680 |
How this provider's Medicaid billing volume and revenue compare to other Maryland providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Maryland 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. | 66 | 80 | 220 | $30 | $82K |
Other providers in the same ZIP code as Jay Berdia, ranked by combined Medicare and Medicaid revenue.
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