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NPI 1194119339 · Flossmoor, IL · Retina Specialist (Ophthalmology) Physician
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Ramon Lee is a retina specialist (ophthalmology) physician provider located in Flossmoor, Illinois. This profile covers 26 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 | Ramon Lee |
| Address | 19550 Governors Hwy Ste 3600 |
| City | Flossmoor |
| State | IL |
| ZIP | 60422 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | March 25, 2015 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4M |
| Medicaid | $8.5K |
This provider is heavily focused on intravitreal biologic therapy: J0178 (aflibercept) alone accounts for $1.9M or 48.3% of Medicare revenue and, together with J2777 (faricimab, $774.3K, 19.4%) and J2778 (ranibizumab, $409.7K, 10.2%), the top three Medicare codes drive 77.9% of the provider’s Medicare revenue. The mix of high-revenue anti-VEGF and related intravitreal injection codes indicates a practice organized around retinal drug delivery for macular disease rather than primarily elective retinal surgery or general ophthalmology services.
Revenue is extremely concentrated in Medicare: the precomputed top three Medicare codes account for 77.9% of total Medicare revenue, while on Medicaid the precomputed top three codes account for 100.0% of Medicaid revenue. This means the provider’s payer revenue is both treatment-specific (intravitreal injections and retinal imaging) and highly concentrated within a handful of CPT/HCPCS items across each payer.
The provider’s overall payer mix is effectively Medicare-dominant: lifetime Medicare revenue is $4M compared with lifetime Medicaid revenue of $8.5K, indicating Medicare drives the business at a scale several orders of magnitude larger than Medicaid. Operational decisions and capacity (staffing, inventory of biologics) are therefore likely optimized around Medicare reimbursement patterns and volumes.
On national competitive standing for key drugs, the provider ranks substantially above many peers for high-value items: J0178 is ranked #215 of 3204 providers nationally (93rd percentile) and is flagged as “notably above typical national volume,” while J2777 (rank #351 of 2039, 83rd percentile) and J2778 (rank #183 of 1208, 85th percentile) are in upper national percentiles but described as typical for their peer groups. These rankings indicate the provider is a major regional/national participant for aflibercept and a meaningful contributor for faricimab and ranibizumab use, rather than a low-volume prescriber.
Beyond injections, diagnostic and exam codes show unusually high activity in Medicare: 92134 (retinal imaging) has $140K revenue and ranks #68 of 26868 providers nationally (100th percentile; extreme outlier), and 92014 (comprehensive established exam) has $167.5K revenue and ranks #295 of 35415 (99th percentile; extreme outlier). This combination of extreme imaging and exam volumes alongside high injection volumes is consistent with a high-throughput retina clinic that pairs frequent OCT imaging and follow visits with intravitreal therapy.
Medicaid billing is narrowly concentrated: 92134 represents $8K or 94.4% of the provider’s total Medicaid revenue and ranks #120 of 250 in-state (52nd percentile), while 92014 represents $476 or 5.6% (rank #1165 of 1234, 4th percentile). The Medicaid profile suggests much lower Medicaid patient volume and limited Medicaid participation in the high-volume injection workflow that dominates the Medicare side.
Procedure breadth includes surgical and in-office procedures but at modest volume relative to injections: codes for retinal repair and vitrectomy (e.g., 67108, 67042) appear with small claim counts and revenue ($15.6K and $13.5K respectively), ranked in mid-to-lower national percentiles. This pattern reinforces that the practice’s core revenue engine is medical retinal care and injections rather than high-volume complex retinal surgery.
The provider has an established Medicare enrollment history (NPI enumerated 2015-03-25, ~11 years ago), which aligns with the sustained high volumes reported for specific retinal therapies and imaging codes. Tenure combined with the observed rank percentiles supports that these billing patterns are persistent and represent an operational specialization rather than a short-term fluctuation.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
26 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,820 | $690 | $1.9M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 26,700 | $30 | $774.3K |
| J2778 | Injection, ranibizumab, 0.1 mg | 2,290 | $180 | $409.7K |
| 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. | 2,560 | $90 | $235.6K |
| 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… | 1,900 | $90 | $167.5K |
| 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. | 4,670 | $30 | $140K |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 330 | $220 | $70.1K |
| 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… | 570 | $90 | $53.3K |
| 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… | 740 | $70 | $48.8K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 200 | $160 | $30.8K |
Showing 1–10 of 26
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 26 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
26 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 3 | 140 | 700 | $690 | $688.4K |
| J2777 | 4 | 90 | 9,180 | $30 | $451K |
| J2778 | 10 | 20 | 540 | $180 | $214.9K |
| Q5128 | 1 | 10 | 270 | $210 | $141.7K |
| J2781 | 2 | 10 | 600 | $120 | $86.8K |
| 67028 | 2 | 190 | 400 | $90 | $64.4K |
| J7312 | 10 | 30 | 240 | $160 | $45.1K |
| J3590 | 55 | 10 | 40 | $320 | $36.1K |
| 92014 | 1 | 1,420 | 130 | $80 | $24.7K |
| J9035 | 10 | 130 | 140 | $60 | $24.6K |
Showing 1–10 of 26
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. | 530 | $20 | $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… | 10 | $30 | $480 |
How this provider's Medicaid billing volume and revenue compare to other Illinois providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Illinois 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… | 1,165 | 1,230 | 450 | $40 | $54.1K |
| 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. | 120 | 250 | 510 | $20 | $20.1K |
Other providers in the same ZIP code as Ramon Lee, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Lourdes Terrado | IL | Nephrology Physician | $199.3K | $182.1K |
| Daniel Yohay | IL | Nephrology Physician | $213.1K | $164.9K |
| Joseph Thometz | IL | Orthopaedic Surgery Physician | $247.9K | $38K |
| April Odom | IL | Family Nurse Practitioner | $171.7K | $14.6K |
| Jerrie Posthumus | IL | Certified Registered Nurse Anesthetist | $77.1K | $0 |
| Pauline Schultz | IL | Certified Registered Nurse Anesthetist | $23.3K | $0 |
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