Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Pennsylvania for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Pennsylvania only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Pennsylvania (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Roy Brod (NPI 1235174483)

Field	Value
Entity Type	Individual
Organization	Roy Brod
Address	2150 Harrisburg Pike Ste 370
City	Lancaster
State	PA
ZIP	17601
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	June 19, 2006

Payer Source	Total Paid
Medicare	$2.8M
Medicaid	$0

Key Findings

Practice profile and tenure: ROY BROD is a retina specialist (Ophthalmology) enumerated since 2006-06-19, indicating roughly 20 years of Medicare registration and established clinical presence in Lancaster, PA. The listed CPT/HCPCS mix is consistent with a retina-focused ophthalmology practice that performs frequent intravitreal injections and posterior-segment imaging rather than primary comprehensive ophthalmology or broad multispecialty services.

Medicare revenue scale and payer mix: Lifetime Medicare revenue on file is $2.8M and there is no Medicaid billing on file, so this provider operates effectively as a Medicare-only biller in available records. Analysts should treat this entity as single-payer in the public claims data, with no Medicaid activity to compare for dual-payer mix assessments.

Revenue concentration in a narrow set of drugs: The top three Medicare codes by revenue account for 74.8% of this provider’s total Medicare revenue, indicating heavy concentration in a small set of injectable therapeutics and related administration services. This concentration suggests the business is largely driven by high-frequency or high-cost intravitreal drug therapy rather than diversified office-based E/M or surgical procedures.

Primary revenue drivers: J0178 (aflibercept) is the single largest revenue driver, generating $1.4M or 51.6% of the provider’s Medicare revenue, followed by J2777 and J2778 which together add substantial share (17.2% and 6.1% respectively). The dominant share from J0178 highlights reliance on aflibercept administration as the core revenue-generating service in this practice.

Service mix and clinical focus: Beyond injections, the provider also bills for posterior segment diagnostics at meaningful volume—92134 (OCT) and 92250 (fundus photography) appear on the top list, with 92134 described as notably above typical national volume and 92250 as an extreme outlier. This combination of high-volume injection codes and elevated imaging codes is consistent with a retina clinic that performs diagnosis, imaging surveillance, and frequent intravitreal therapy.

Competitive standing on key codes: For major drug codes the provider’s national ranks are in the mid-to-high percentiles (J0178 at the 84th percentile, J2777 at the 68th, J2778 at the 62nd), indicating typical to above-typical participation nationally but not dominance. Conversely, J0179 shows a low absolute provider pool and a mid-percentile rank (44th) and imaging codes like 92250 and 92134 rank extremely high nationally (99th and 96th percentiles), signaling outsized imaging volume relative to peers.

Procedure-level anomalies and outliers: Several imaging codes are flagged as statistical outliers—92250 is an extreme outlier (99th percentile) and 92134 is notably above typical national volume (96th percentile). These flags indicate the practice devotes substantially more billing activity to fundus photography and OCT than most peers, which may reflect either a higher throughput imaging workflow or a specialized diagnostic emphasis within the retina service line.

Scope of office visits and surgical activity: Evaluation-and-management codes (99214, 99213) and intermediate/new patient eye exams (92012, 92014, 92004) appear but contribute a small share of revenue relative to drug and imaging codes, indicating the clinical model emphasizes procedure-driven encounters over revenue from routine comprehensive E/M visits. Surgical codes such as 67036 are present but at low volume, consistent with a clinic that primarily delivers in-office injections and diagnostics rather than frequent posterior-segment surgery.

Implications for payers and network strategy: Given the provider’s reliance on intravitreal drugs (notably aflibercept) and elevated imaging volumes, payers and network planners should view this clinician as a high-volume retinal therapeutic and diagnostic resource in Lancaster, with predictable Medicare revenue flows concentrated in a few injectable agents. Absence of Medicaid billing suggests limited exposure to Medicaid populations through this NPI, so negotiations or access planning should not assume Medicaid case mix without further affiliation-level data.

Medicare: Complete Services Breakdown

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

23 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	2,090	$690	$1.4M
J2777	Injection, faricimab‑svoa, 0.1 mg	16,560	$30	$480.2K
J2778	Injection, ranibizumab, 0.1 mg	940	$180	$169.4K
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.	1,730	$90	$154.2K
J0179	Injection, brolucizumab-dbll, 1 mg	400	$250	$98.2K
J3490	Unclassified drugs	50	$1,690	$76.2K
J7312	Injection, dexamethasone, intravitreal implant, 0.1 mg	410	$160	$64.1K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	530	$120	$63K
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.	1,830	$30	$53.2K
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…	450	$90	$39.5K

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

Claims Volume vs. Pennsylvania Distribution

Roy Brod — 2 of 23 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. state median

23 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	31	140	830	$690	$865.1K
J2778	38	70	1,030	$190	$417.1K
J2777	26	100	7,950	$30	$360.2K
J0179	2	10	540	$250	$133.2K
J2781	14	20	690	$120	$109.1K
67028	35	180	600	$90	$87.5K
J3590	11	10	40	$1,690	$78K
J7312	5	10	280	$160	$50.7K
J7999	12	110	100	$120	$33.3K
J3490	70	110	60	$70	$27.9K

Showing 1–10 of 23

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Dina Gewaily	PA	Ophthalmology Physician	$1.8M	$2.7K
Philip Scharper	PA	Retina Specialist (Ophthalmology) Physician	$1.6M	$0
Salman Porbandarwalla	PA	Retina Specialist (Ophthalmology) Physician	$1.6M	$0
Lili Kaplan	PA	Retina Specialist (Ophthalmology) Physician	$987.9K	$0
Rupak Bhuyan	PA	Ophthalmology Physician	$42.1K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bayada Home Health Care, Inc.	PA	Home Health Agency	$0	$34.4M
Andventure, LLC	PA	Home Health Agency	$0	$26.7M
Efcc Acquisition Corp	PA	Home Health Agency	$0	$13.1M
Smilebuilderz LLC	PA	Dentist	$0	$11.5M
Teamcare Behavioral Health, LLC	PA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$8.3M
Horizon Healthcare Services, LLC	PA	Home Infusion Therapy Pharmacy	$12.2K	$6.5M
Penn State Health Lancaster Medical Center	PA	General Acute Care Hospital	$0	$5.4M
Advanced Surgery Center Of Lancaster, LLC	PA	Ambulatory Surgical Clinic/Center	$4M	$0
Midatlantic Endoscopy LLC	PA	Ambulatory Surgical Clinic/Center	$1.2M	$183.7K
Lancaster Pet Partnership, LLP	PA	Radiology Clinic/Center	$1.4M	$0

Roy Brod — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References