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NPI 1184604845 · Wyomissing, PA · Retina Specialist (Ophthalmology) Physician
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Barry Malloy is a retina specialist (ophthalmology) physician provider located in Wyomissing, Pennsylvania. This profile covers 19 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 | Barry Malloy |
| Address | 1 Granite Point Dr Ste 100 |
| City | Wyomissing |
| State | PA |
| ZIP | 19610 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | January 19, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.3M |
| Medicaid | $1.8K |
This provider’s payer mix is heavily Medicare-weighted: total Medicare revenue is $3.3M versus total Medicaid revenue of $1.8K, so Medicaid activity is negligible in scale and the practice is effectively single-payer (Medicare) for revenue. The NPI was enumerated on 2006-01-19 (~20 years ago), indicating long-standing participation in Medicare billing.
Revenue concentration on Medicare is very high: the precomputed top 3 Medicare codes by revenue account for 85.1% of this provider's total Medicare revenue, with J0178 (42.8%) and J2777 (36.7%) together representing the vast majority of Medicare dollars and 67028 contributing a further 5.6%. This concentration indicates most Medicare income is driven by a small set of injection-related services.
The code mix signals a retina-focused, injection-centric clinical model: dominant codes J0178 and J2777 are intravitreal drug injections (aflibercept and faricimab) and 67028 describes intravitreal injection as a separate procedure. That pattern, together with ancillary codes for retinal imaging and follow-up visits, is consistent with ongoing, procedure-driven management of retinal disease requiring repeated in-office injections.
Competitive standing for the high-cost injection drugs is modest rather than dominant: J0178 ranks #531 of 3204 providers nationally (83th percentile; labeled as typical, unremarkable volume) and J2777 ranks #157 of 2039 (92th percentile; typical, unremarkable volume). In plain terms, the provider is an active biller of these biologics but is not an extreme national outlier or market leader for those specific drug codes.
By contrast, the provider is an extreme national outlier for certain evaluation and diagnostic services: 92014 (comprehensive established patient eye exam) ranks #374 of 35415 providers nationally and 92134 (retinal imaging) ranks #256 of 26868, both noted as “extreme outlier, far above typical national volume.” This indicates unusually high throughput for comprehensive exams and retinal imaging relative to national peers, supporting the picture of a high-volume retina practice.
Medicaid billing is highly concentrated and low-volume: the top Medicaid codes, 92134 (65.8%) and 92014 (34.2%), together account for the provider’s Medicaid revenue and the precomputed top 3 Medicaid codes account for 100.0% of total Medicaid revenue. State-level ranks (92134 at #139 of 183, 24th percentile; 92014 at #742 of 861, 13th percentile) show a modest in-state Medicaid presence rather than a leading role.
Operationally, dependence on high-cost, buy-and-bill biologics (J0178, J2777, plus smaller contributions from J2778 and J7312) means the practice’s revenue is sensitive to drug reimbursement, acquisition costs, and payer coverage policies. Given that the top 3 Medicare codes account for 85.1% of Medicare revenue, changes in reimbursement or utilization of these specific drugs could materially affect practice revenue.
Clinical workflow is consistent with chronic disease management: a combination of very high-volume retinal imaging (92134), frequent follow-up E/M visits (99213 ranks #6205 of 457151 providers, 99th percentile, labeled “extreme outlier, far above typical national volume”), and recurring injections suggests a stable panel of patients requiring repeated visits and procedures rather than episodic surgical work. This mix has implications for scheduling, supply chain, and payer contract negotiations.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
19 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,020 | $690 | $1.4M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 41,400 | $30 | $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. | 1,970 | $90 | $182.7K |
| 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… | 1,780 | $80 | $142.3K |
| 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. | 3,370 | $30 | $104.4K |
| 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… | 1,020 | $70 | $72.1K |
| J2778 | Injection, ranibizumab, 0.1 mg | 260 | $180 | $47.9K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 290 | $160 | $45.3K |
| J7999 | Compounded drug, not otherwise classified | 530 | $70 | $35.2K |
| 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… | 20 | $880 | $13.2K |
Showing 1–10 of 19
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 19 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
19 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 33 | 140 | 830 | $690 | $865.1K |
| J2778 | 57 | 70 | 1,030 | $190 | $417.1K |
| J2777 | 4 | 100 | 7,950 | $30 | $360.2K |
| 67028 | 29 | 180 | 600 | $90 | $87.5K |
| J7312 | 6 | 10 | 280 | $160 | $50.7K |
| J7999 | 8 | 110 | 100 | $120 | $33.3K |
| 67042 | 36 | 50 | 20 | $1,100 | $31.9K |
| 92014 | 13 | 1,570 | 130 | $80 | $21K |
| 99214 | 22,088 | 23,230 | 100 | $80 | $14.5K |
| 92012 | 395 | 930 | 80 | $60 | $14K |
Showing 1–10 of 19
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 |
|---|---|---|---|---|
| 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 | $20 | $1.2K |
| 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… | 20 | $30 | $600 |
How this provider's Medicaid billing volume and revenue compare to other Pennsylvania providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Pennsylvania median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 742 | 860 | 240 | $40 | $37K |
| 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. | 139 | 180 | 290 | $20 | $24.8K |
Other providers in the same ZIP code as Barry Malloy, ranked by combined Medicare and Medicaid revenue.
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