Loading...
NPI 1134309172 · New Orleans, LA · Ophthalmology Physician
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Sagar Patel is a ophthalmology physician provider located in New Orleans, Louisiana. This profile covers 17 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 | Sagar Patel |
| Address | 1430 Tulane Ave |
| City | New Orleans |
| State | LA |
| ZIP | 70112 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | November 7, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.5M |
| Medicaid | $270 |
Service mix indicates a retina-focused ophthalmology practice driven by intravitreal biologic therapy and diagnostic imaging: J0178 (aflibercept) accounts for $1.2M and 76.4% of Medicare revenue with 1.7K claims and a $691 avg paid/claim, complemented by 67028 (intravitreal injection) at $127.5K (8.3%) and 92134 (retinal imaging) at $49.6K (3.2%). The presence of J3590 (unclassified biologics) and J7312 (dexamethasone implant) further supports a procedural mix centered on pharmacologic retinal treatments and device/implant coding rather than predominantly routine primary-care E/M services.
Revenue concentration is high: the precomputed top three Medicare codes account for 89.6% of this provider's total Medicare revenue, and the precomputed top three Medicaid codes account for 100.0% of Medicaid revenue (in practice here represented entirely by 92134). This concentration means most reimbursement depends on a narrow set of injection and imaging services, increasing sensitivity to shifts in drug pricing, coverage, or utilization for those specific codes.
Payer mix is effectively single-payer dominated by Medicare: lifetime Medicare revenue is $1.5M versus lifetime Medicaid revenue of $271, indicating negligible Medicaid contribution to overall revenue. Analysts should treat this provider as Medicare-centric for revenue risk and utilization benchmarking.
For the lead therapeutic code J0178 the provider ranks #690 of 3204 nationally (78th percentile) and is characterized as “typical, unremarkable volume,” meaning the provider participates at a common level for aflibercept administration rather than as a national outlier. Similarly, 67028 ranks #820 of 4255 (81th percentile; typical, unremarkable volume), supporting the view that injection practice volume is substantial but not exceptional at the national level.
The provider shows atypically high volumes for office exams and retinal testing: 92012 ranks #267 of 17177 (98th percentile; extreme outlier, far above typical national volume), and 92134 ranks #1248 of 26868 (95th percentile; notably above typical national volume). These rankings suggest the provider delivers far more intermediate-level ophthalmologic exams and retinal imaging than most peers, indicating a busy clinic workflow with frequent follow-up visits and diagnostics.
Medicaid activity is minimal and geographically limited: all Medicaid revenue ($271) is from 92134 (12 claims) and that Medicaid 92134 entry ranks #133 of 133 in-state (0th percentile; typical, unremarkable volume). This pattern signals a very small Medicaid footprint locally and little state-level market share to analyze for Medicaid-specific contracting or utilization initiatives.
Tenure and operational scale support a sustained practice presence: the NPI was enumerated 2007-11-07 (~19 years ago), and high claim counts on key codes (for example 1.7K claims for J0178 and 1.8K claims for 92134 on Medicare) indicate long‑running, steady throughput in procedural retinal services. Combined with $1.5M lifetime Medicare revenue, these facts point to an established, procedure-heavy outpatient ophthalmology operation rather than a newly formed or primarily consultative practice.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
17 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 1,700 | $690 | $1.2M |
| 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. | 1,480 | $90 | $127.5K |
| 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… | 1,260 | $60 | $75.7K |
| 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. | 1,770 | $30 | $49.6K |
| J3590 | Unclassified biologics | 740 | $50 | $34.2K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 130 | $160 | $20.9K |
| 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… | 130 | $100 | $12.4K |
| 67210 | The provider destroys a lesion of the retina using a laser beam that heats up the tissue. | 30 | $370 | $9.9K |
| 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… | 10 | $810 | $9.8K |
| 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… | 70 | $80 | $5.5K |
Showing 1–10 of 17
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 17 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
17 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 3 | 50 | 300 | $680 | $371.5K |
| J3590 | 1 | 10 | 70 | $490 | $92K |
| 67028 | 4 | 70 | 410 | $80 | $44.3K |
| J7312 | 6 | 10 | 200 | $150 | $39.1K |
| 67042 | 17 | 20 | 20 | $1,110 | $26.6K |
| 92014 | 362 | 470 | 170 | $80 | $23.9K |
| 67210 | 9 | 10 | 40 | $380 | $16.5K |
| 99214 | 4,479 | 6,670 | 110 | $80 | $16.5K |
| 92012 | 6 | 350 | 100 | $60 | $11.7K |
| 92235 | 12 | 40 | 70 | $90 | $11.3K |
Showing 1–10 of 17
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. | 10 | $20 | $280 |
How this provider's Medicaid billing volume and revenue compare to other Louisiana providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Louisiana 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. | 133 | 130 | 490 | $10 | $19.4K |
Other providers in the same ZIP code as Sagar Patel, ranked by combined Medicare and Medicaid revenue.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.