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NPI 1144255936 · Bellevue, WA · Ophthalmology Physician
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Charles Birnbach is a ophthalmology physician provider located in Bellevue, Washington. This profile covers 22 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 | Charles Birnbach |
| Address | 1750 112th Ave Ne |
| City | Bellevue |
| State | WA |
| ZIP | 98004 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | July 11, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.4M |
| Medicaid | $0 |
Provider profile and tenure: CHARLES BIRNBACH is an ophthalmology physician based in BELLEVUE, WA, with an NPI enumerated ~20 years ago (2006-07-11), indicating long-standing participation in Medicare billing and an established clinical presence in the market. Ten years-plus tenure supports continuity of care and likely an established referral base for retina and intravitreal therapy work.
Revenue scale and payer mix: This provider’s lifetime Medicare revenue is $2.4M while Medicaid revenue is $0, indicating an effectively single-payer footprint focused exclusively on Medicare beneficiaries; there is no Medicaid billing on file to suggest participation in that program. Analysts should treat comparisons and competitive posture through a Medicare-only lens for this provider.
High revenue concentration in a small number of medication codes: The top 3 Medicare codes by revenue account for 73.7% of this provider’s Medicare revenue, showing marked concentration in a few high-cost drug and unclassified-drug codes rather than a broad service mix. This concentration implies the practice’s economics are heavily dependent on reimbursed intravitreal pharmaceuticals and related drug administration.
Service-line implications from top codes: The dominant code J0178 (aflibercept injection) is the single largest revenue driver at $1.4M (57.1% of Medicare revenue) and, together with J2777 (faricimab) and J3490 (unclassified drugs), signals that intravitreal anti-VEGF and other injectable therapies are the core clinical service line. The presence of procedural retina codes such as 67028 and 67042 alongside high volumes of imaging 92134 reinforces that this provider operates as a retina-focused ophthalmology practice performing injections, diagnostic retinal imaging, and occasional vitreoretinal procedures.
Competitive standing on key codes: For the highest-volume drug J0178 the provider ranks #525 of 3204 (84th percentile), which positions them above the median nationally but not among the very largest injectors; this is a solid, above-typical contributor to the national supply of aflibercept administrations. Similarly, 92134 (retinal imaging) ranks in the 96th percentile (#991 of 26868), indicating notably above-typical utilization of diagnostic retinal imaging relative to peers and suggesting a strong emphasis on retinal disease management.
Mixed national percentile picture across other codes: Several procedure and office-visit codes (e.g., 67028 at the 73rd percentile, 99213 at the 94th percentile, and 67036 at the 80th percentile) show consistently above-median utilization, while other drug and unclassified biologics codes (e.g., J3590 at the 7th percentile) are low or modest relative to national peers. This pattern indicates the practice concentrates on a narrow set of high-value medications and retinal services while having limited activity in some other biologic or less-common procedures.
Revenue-per-claim and billing profile: The top drug J0178 has a high average paid per claim ($689) and large claim volume (2K claims), producing the dominant revenue share; by contrast J2777 shows many more claims (8.3K) but a much lower avg paid/claim ($29), reflecting differences in unit pricing and how claim counts map to revenue. These differences matter for contract negotiations and utilization management since payment-per-injection and claim frequency both shape total spend.
Operational and contracting implications: Given the heavy dependence on a small set of injectable drugs and high utilization of retinal imaging, payers and provider analysts should prioritize review of drug acquisition pathways, buy-and-bill arrangements, and prior authorization patterns for intravitreal therapies when assessing network value and cost drivers. The lack of Medicaid billing further simplifies payer negotiations to Medicare-focused arrangements and risk-sharing structures.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
22 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,030 | $690 | $1.4M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 8,340 | $30 | $241.9K |
| J3490 | Unclassified drugs | 70 | $2,280 | $164.3K |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 680 | $220 | $146.7K |
| 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. | 1,180 | $110 | $127.1K |
| 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. | 2,050 | $30 | $67.7K |
| 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… | 540 | $100 | $52.6K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 440 | $120 | $52.2K |
| 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… | 40 | $970 | $41.5K |
| 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… | 490 | $70 | $34.2K |
Showing 1–10 of 22
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 22 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
22 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J2777 | 34 | 50 | 12,780 | $30 | $599.7K |
| J0178 | 15 | 90 | 470 | $680 | $597.2K |
| Q5128 | 6 | 10 | 520 | $220 | $136.6K |
| J2781 | 11 | 10 | 650 | $120 | $88.6K |
| 67028 | 32 | 110 | 550 | $90 | $72.9K |
| J3490 | 30 | 70 | 70 | $50 | $51.2K |
| 67042 | 5 | 40 | 30 | $1,190 | $39.2K |
| 67108 | 13 | 20 | 20 | $1,180 | $29.6K |
| 67036 | 4 | 20 | 20 | $1,140 | $28.6K |
| J3590 | 5 | 10 | 20 | $980 | $24.4K |
Showing 1–10 of 22
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
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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. | 60 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Washington providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Washington 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. | 70 | 100 | 240 | $10 | $22.2K |
Other providers in the same ZIP code as Charles Birnbach, ranked by combined Medicare and Medicaid revenue.
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