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NPI 1275776049 · Hagerstown, MD · Ophthalmology Physician
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David Warrow is a ophthalmology physician provider located in Hagerstown, Maryland. This profile covers 35 Medicare and 4 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 | David Warrow |
| Address | 1800 Dual Hwy |
| City | Hagerstown |
| State | MD |
| ZIP | 21740 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | April 9, 2009 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $15.1M |
| Medicaid | $8.3K |
DAVID WARROW is a long-tenured ophthalmology physician with an NPI enumerated on 2009-04-09 (~17 years ago), indicating an established practice history in HAGERSTOWN, MD that can support sustained billing volume and procedural throughput over time. Tenure combined with procedural intensity suggests a mature specialty practice rather than a recently started solo clinic.
Medicare dominates this provider’s public payer revenue: Total Medicare revenue is $15.1M versus Total Medicaid revenue of $8.3K, indicating the provider is effectively single-payer dominant on the public side with Medicare accounting for almost all reported public-payer billing. This scale disparity implies strategic emphasis on Medicare beneficiaries and services typically reimbursed by Medicare.
Revenue concentration in Medicare is highly focused: the precomputed top 3 Medicare codes by revenue account for 62.3% of the provider’s total Medicare revenue. Those top revenue-driving codes include high-value intravitreal drug administrations and related retinal procedures (e.g., Q5124, J2777, J2781), which signals a service-line specialization in medical retina and frequent intravitreal therapy delivery. This code mix is consistent with a practice centered on injection-based retinal disease management rather than primarily refractive or routine ophthalmic care.
The provider is a national outlier on several blockbuster Medicare codes. Q5124 ($5M revenue, 29.1K claims) and J2781 ($1.8M revenue, 15.2K claims) both rank #1 nationally and are labeled as extreme outlier — indicating exceptionally high volume for these biosimilar and intravitreal drug codes compared with peers. Additionally, J2403 ($1.4M revenue) and multiple diagnostic imaging and injection procedure codes rank at or near the top percentiles (many at 100th percentile), reinforcing that this clinician is a dominant, high-volume supplier of intravitreal therapies and specialized retinal services at a national competitive standing.
Several other Medicare codes show above-typical or notably high volume relative to peers, supporting a broad retinal procedure footprint. Examples include 67028 (rank #2 nationally), 92134 (rank #3 nationally), and 92242 (rank #3 nationally); these are described as extreme outliers or notably above typical national volume and together indicate high throughput for injections, OCT imaging, and angiographic studies. This pattern suggests integrated diagnostic and therapeutic retinal capabilities within the practice, enabling same-site imaging plus intravitreal treatment.
Certain billing lines show more typical or unremarkable standing despite the overall high-volume profile. For example, J3490 ($2.7M revenue) ranks #26 nationally at the 99th percentile and J3590 ranks in the 36th percentile; these labels indicate that while unclassified drug billing contributes materially to revenue, not all drug categories are nationally exceptional. Analysts should note that some high-revenue drug codes are extreme outliers while other drug/biologic codes fall within more typical ranges.
Medicaid billing is minimal in absolute terms but concentrated in a small set of codes: the precomputed top 3 Medicaid codes account for 100.0% of Medicaid revenue, with 92134 representing 70.4% of Medicaid revenue and 67028 representing 28.0%. This indicates the provider’s Medicaid activity is narrowly focused on retinal imaging and intravitreal injections, mirroring the Medicare service mix but at much lower scale. Within-state rank for these Medicaid codes is modest (92134 at 57th percentile in-state and 67028 at 18th percentile), so the provider is not a dominant Medicaid retinal provider in Maryland.
From a business implication perspective, the heavy Medicare reliance on intravitreal drug administration and diagnostic retinal services implies revenue sensitivity to drug pricing, reimbursement changes for injection codes, and shifts in therapy patterns (e.g., biosimilars or new agents). The practice’s competitive advantage appears to be high procedural volume and integrated imaging + injection capacity, which supports economies of scale for retina-focused care but also concentrates financial exposure in a few high-revenue codes. Analysts should treat this as a specialized retina clinic footprint rather than a general ophthalmology practice.
Overall competitive standing is mixed by payer: nationally and within Medicare the provider is a major, sometimes extreme outlier on several retina and drug administration codes, reflecting market leadership in those specific services. By contrast, Medicaid activity is minimal and ranks at or below median in-state for comparable codes, indicating limited presence in the Medicaid market and potential vulnerability if payer mix or referral sources shift toward lower-reimbursement populations.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
35 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 29,150 | $170 | $5M |
| J3490 | Unclassified drugs | 1,390 | $1,940 | $2.7M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 69,840 | $30 | $2M |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 15,240 | $120 | $1.8M |
| J2403 | Chloroprocaine hcl ophthalmic, 3% gel, 1 mg | 1,386,400 | $1 | $1.4M |
| 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. | 7,260 | $100 | $740.9K |
| 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… | 4,280 | $100 | $406.9K |
| 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. | 8,170 | $30 | $245.1K |
| 92242 | The provider injects two different special dyes into one or both eyes that cause the blood vessels to stand out in photographic images timed so that multiple frames are taken in rapid succession. He… | 1,030 | $210 | $210.7K |
| J3590 | Unclassified biologics | 60 | $2,510 | $137.9K |
Showing 1–10 of 35
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 35 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
35 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| Q5124 | 1 | 10 | 17,150 | $170 | $2.6M |
| J0178 | 96 | 100 | 950 | $690 | $887.3K |
| J2403 | 1 | 10 | 860,000 | $1 | $506.2K |
| J2777 | 3 | 70 | 8,520 | $30 | $487.3K |
| J2781 | 1 | 20 | 620 | $120 | $258.6K |
| J3590 | 10 | 20 | 50 | $2,390 | $128.9K |
| 67028 | 1 | 120 | 700 | $100 | $101.5K |
| J7314 | 1 | 10 | 230 | $410 | $96.6K |
| J3299 | 1 | 10 | 1,730 | $40 | $65.3K |
| 92242 | 1 | 10 | 210 | $210 | $63.4K |
Showing 1–10 of 35
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.
4 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. | 390 | $20 | $5.8K |
| 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. | 70 | $30 | $2.3K |
| 92201 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 10 | $10 | $130 |
| 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… | 20 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Maryland providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Maryland median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 3,102 | 3,280 | 610 | $80 | $296.1K |
| 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. | 24 | 30 | 460 | $40 | $103K |
| 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. | 35 | 80 | 220 | $30 | $82K |
| 92201 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 16 | 20 | 110 | $20 | $31.2K |
Other providers in the same ZIP code as David Warrow, ranked by combined Medicare and Medicaid revenue.
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