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    OpenPayerNPI Medicare & MedicaidSushant Wagley
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    Sushant Wagley — Billing Profile & Reimbursement Data

    NPI 1225481351 · West Des Moines, IA · Retina Specialist (Ophthalmology) Physician

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    Sushant Wagley is a retina specialist (ophthalmology) physician provider located in West Des Moines, Iowa. This profile covers 23 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationSushant Wagley
    Address1501 50th St Ste 133
    CityWest Des Moines
    StateIA
    ZIP50266
    TaxonomyRetina Specialist (Ophthalmology) Physician
    NPI EnumeratedJuly 13, 2016

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$1.8M
    Medicaid$0

    Key Findings

    This clinician is operating as a procedure-focused retina specialist: the top revenue drivers are intravitreal biologic injections and retina diagnostic imaging, with J2777 (faricimab) and J0178 (aflibercept) dominating the mix alongside retinal imaging code 92134. The presence of high-volume injection codes (J2777: 35.8K claims, $1M revenue; J0178: 564 claims, $389.7K revenue) and substantial imaging (92134: 1.6K claims, $45.3K revenue) aligns with a medical-retina practice model centered on repeated injections and longitudinal retinal monitoring rather than high-volume surgical procedures.

    Revenue is highly concentrated: the precomputed top 3 Medicare codes account for 86.0% of this provider's total Medicare revenue, and Medicare totals $1.8M in lifetime revenue. That concentration indicates financial dependence on a small set of therapeutics and associated services, with J2777 alone representing $1M (58.9% of Medicare revenue) of the total.

    This provider is effectively single-payer at the available claims level: Medicare billing totals $1.8M while Medicaid shows none on file. The absence of Medicaid claims suggests limited or no participation in state Medicaid programs, so payer mix and risk exposure are heavily weighted to Medicare reimbursement dynamics.

    Competitive standing on the top biologic is relatively strong: J2777 ranks #205 of 2039 nationally (90th percentile; typical, unremarkable volume for this code), which places the provider above most peers on faricimab administration even though the dataset labels the volume as typical for the code. By contrast J0178 ranks #1819 of 3204 (43th percentile; typical, unremarkable volume), indicating more modest relative use of aflibercept versus national colleagues.

    Several codes show notably high relative imaging and consultation volumes: 92134 ranks #1453 of 26868 providers nationally (95th percentile; notably above typical national volume), suggesting this practice produces above-typical retinal imaging volume consistent with active monitoring of chronic retinal disease. Concurrently, 92250 and 92235 appear with moderate volumes (92250: 218 claims; 92235: 53 claims) supporting a workflow that integrates fundus photography and angiography into routine retinal care.

    The provider posts an unusual pattern in new-patient evaluation coding: 99204 has 341 claims and $38.2K revenue and is described as 100th percentile (extreme outlier, far above typical national volume). This suggests a disproportionately high count of complex new outpatient E/M encounters relative to peers, which may reflect referral-driven consultations or coding patterns emphasizing high-complexity new visits.

    Surgical retinal procedures are present but represent a small share of revenue and volume: 67028 accounts for $88.1K (5.0% of Medicare revenue) with 968 claims and ranks #1434 of 4255 (66th percentile; typical, unremarkable volume), while vitrectomy and membrane-peeling codes (e.g., 67036, 67041, 67042) are low-volume contributors. The code mix therefore implies a practice that performs some surgical interventions but primarily generates revenue from injections and diagnostics.

    Provider tenure is established but not long-tenured by historical standards: the NPI was enumerated on 2016-07-13 (~10 years ago). That tenure is long enough to build a referral base and the accumulated Medicare volume shown here, but the revenue concentration and payer profile remain important considerations for evaluating growth or diversification opportunities.

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

    The CPT/HCPCS codes generating the most Medicare revenue for this provider.

    23 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J2777Injection, faricimab‑svoa, 0.1 mg35,820$30$1M
    J0178Injection, aflibercept, 1 mg560$690$389.7K
    67028The 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.970$90$88.1K
    92134The 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.1,560$30$45.3K
    92014An 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…490$90$41.7K
    99204The provider sees a new 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 provider…340$110$38.2K
    99214The 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…210$90$20K
    J3590Unclassified biologics230$70$16.3K
    92012For 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…190$60$11.7K
    67036The provider removes vitreous fluid from the eye to access the posterior segment of the eye and introduce surgical instruments through incisions in the pars plana.20$580$11.5K

    Showing 1–10 of 23

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 23 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    23 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J2777142043,140$30$1.7M
    J01782240640$690$760.2K
    670281860420$80$80.6K
    67042202020$900$28.8K
    J35901330140$100$26.7K
    9201484500200$70$19.8K
    6703921020$1,020$16.3K
    6703651020$740$15.5K
    992141,3884,690100$70$14.4K
    6704141010$980$11.7K

    Showing 1–10 of 23

    Related Providers

    Other providers that share a Tax Identification Number (TIN) with Sushant Wagley, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Thomas BurokerIAMedical Oncology Physician$9.4M$0
    Kyle AllimanIAOphthalmology Physician$8.7M$0
    Alex KartvelishviliIAOphthalmology Physician$8.1M$0
    Paul BoekeIAOphthalmology Physician$7.1M$0
    Austin StrohbehnIARetina Specialist (Ophthalmology) Physician$5.8M$0
    Jeremy DeutschKSHematology & Oncology Physician$5.7M$0
    Robert BehrensIAMedical Oncology Physician$5.2M$0
    Matthew McknightIAFoot & Ankle Surgery Podiatrist$4.7M$23.5K
    James SingerIARetina Specialist (Ophthalmology) Physician$4.1M$0
    Christopher HaupertIARetina Specialist (Ophthalmology) Physician$3.9M$0

    Nearby Providers

    Other providers in the same ZIP code as Sushant Wagley, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Iowa Physicians Clinic Medical FoundationIAGeneral Practice Physician$0$102.7M
    Link AssociatesIAIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility$0$83.3M
    Iowa Family Services, IncIACommunity/Behavioral Health Agency$0$9.9M
    Revell-warrington Dental PCIAPediatric Dentistry$0$9.2M
    CsaIACommunity/Behavioral Health Agency$0$8.8M
    City Of West Des MoinesIALand Ambulance$726.2K$5.1M
    Wolfe Surgery Center, LLCIAAmbulatory Surgical Clinic/Center$4.1M$1.3M
    Iowa Home Care, LLCIAHome Health Agency$0$5.4M
    The Iowa Clinic PCIAFamily Medicine Physician$0$5.4M
    Divine Touch Of Iowa LLCIAIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility$0$4.8M

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    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.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. Iowa Distribution
    Sushant Wagley — 2 of 23 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Iowa