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    OpenPayerNPI Medicare & MedicaidMatthew Cole
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    Matthew Cole — Billing Profile & Reimbursement Data

    NPI 1285889311 · Knoxville, TN · Ophthalmology Physician

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    Matthew Cole is a ophthalmology physician provider located in Knoxville, Tennessee. This profile covers 18 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
    OrganizationMatthew Cole
    Address12744 Kingston Pike
    CityKnoxville
    StateTN
    ZIP37934
    TaxonomyOphthalmology Physician
    NPI EnumeratedNovember 17, 2008

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

    Payer SourceTotal Paid
    Medicare$3.3M
    Medicaid$0

    Key Findings

    This provider reports $3.3M in lifetime Medicare revenue and has no Medicaid billing on file, so its public payer activity is effectively single–payer Medicare. The absence of Medicaid claims means analyses of in-state Medicaid market share or dual-payer mix are not possible from this record.

    Revenue is highly concentrated: the precomputed top three Medicare codes (J0178, J2777, Q5124) account for 89.4% of the provider's Medicare revenue, with J0178 alone contributing $2.4M (72.7% of Medicare revenue). That concentration signals heavy dependence on a small set of injection codes for the practice’s Medicare income.

    The code mix (J0178, J2777, Q5124 plus 67028 and retina imaging codes such as 92134 and 92250) is consistent with a retina-focused ophthalmology practice that delivers frequent intravitreal anti-VEGF injections and provides ancillary diagnostic imaging and follow-up exams. Presence of 67028 (2K claims, $172.8K revenue) alongside the drug codes reflects that injections are billed as isolated/separate procedures.

    J0178 performance is a national outlier in volume: 3.6K claims, $683 avg paid/claim, $2.4M revenue and a national rank of #104 of 3204 providers (97th percentile) with a label of notably above typical national volume. This ranking positions the provider as a major national injector of aflibercept among Medicare billers rather than a modest participant.

    Imaging and exam services also run at above-typical national volumes: 92014 (862 claims, $72.4K revenue) ranks #2247 of 35415 (94th percentile), 92134 (2.1K claims, $59.8K revenue) ranks #981 of 26868 (96th percentile), and 92250 (492 claims, $13.3K revenue) ranks #1251 of 25087 (95th percentile). Those high percentiles indicate steady throughput of diagnostic imaging and comprehensive/established-patient visits that support ongoing injection-based treatment.

    Adoption of alternate injectable agents and biosimilars appears present but secondary to aflibercept: J2777 shows $381.1K revenue (11.4% of Medicare revenue) with rank #793 of 2039 (61th percentile) and Q5124 shows $178.7K (5.3% of Medicare revenue) with rank #32 of 122 (74th percentile). In plain terms, the provider bills for faricimab and a ranibizumab biosimilar at measurable but modest levels compared with the dominant J0178 volume.

    The provider’s NPI was enumerated on 2008-11-17 (~18 years ago), indicating an established billing history that corresponds with sustained procedure volumes rather than a newly entered practice. That tenure, combined with the concentrated injection volume, suggests an operational model built around long-term retinal care delivery.

    Because a large share of Medicare revenue is driven by a small set of intravitreal drug codes (top three = 89.4%), the practice’s Medicare revenue profile is sensitive to changes in drug utilization, reimbursement, or formulary preference; payers and analysts should monitor shifts among J0178, J2777, and Q5124 to detect material revenue or utilization changes.

    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.

    18 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J0178Injection, aflibercept, 1 mg3,560$680$2.4M
    J2777Injection, faricimab‑svoa, 0.1 mg13,140$30$381.1K
    Q5124Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg1,070$170$178.7K
    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.1,960$90$172.8K
    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…860$80$72.4K
    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.2,060$30$59.8K
    92250Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,…490$30$13.3K
    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…120$60$7.4K
    92004The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits.70$90$6.8K
    J9035Injection, bevacizumab, 10 mg110$50$5.7K

    Showing 1–10 of 18

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 18 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    18 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J0178280790$680$769.8K
    J2777315015,060$30$592.1K
    Q5124310690$180$137.8K
    6702815801,130$90$98.5K
    9201450810120$80$19.2K
    J90354470140$50$17.1K
    9921411,19011,370120$80$16.6K
    992152,6422,71040$110$8.3K
    921343360060$30$8.2K
    9921310,38911,03080$50$8K

    Showing 1–10 of 18

    Related Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Kentucky Medical Services Foundation, IncKYInternal Medicine Physician$0$110.4M
    Columbus Radiology CorpOHDiagnostic Radiology Physician$0$49.9M
    Retina And Vitreous Associates Of Kentucky PLLCKYRetina Specialist (Ophthalmology) Physician$0$13.3M
    Kentucky Medical Services FoundationKYNurse Practitioner$0$12.5M
    Nathan SteinleCARetina Specialist (Ophthalmology) Physician$9.5M$0
    Shil PatelVAOphthalmology Physician$6.1M$0
    James PateNCOphthalmology Physician$5.2M$0
    Nitin GuptaNCOphthalmology Physician$4.7M$0
    Kyle ThompsonIDRetina Specialist (Ophthalmology) Physician$4.5M$0
    John KitchensKYRetina Specialist (Ophthalmology) Physician$3.5M$514.7K

    Nearby Providers

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

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    East Tennessee Children's Hospital Association, IncTNDurable Medical Equipment & Medical Supplies$0$20.3M
    Otolaryngology Head And Neck Surgery AssociatesTNSpecialist$0$2.3M
    Sara DajaniTNFamily Nurse Practitioner$1.6M$0
    Eric RedmonTNFamily Medicine Physician$217.4K$643.2K
    Endoscopy Center Of Knoxville LPTNAmbulatory Surgical Clinic/Center$488.2K$0
    Michael CollierTNInternal Medicine Physician$244.4K$0
    Nilamkumar PatelTNClinical Cardiac Electrophysiology Physician$227.9K$0
    Kimberly LoweTNFamily Nurse Practitioner$204.6K$0
    Harold SilverTNGastroenterology Physician$199.2K$100
    Kyler ThomasTNFoot & Ankle Surgery Podiatrist$194.9K$0

    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. Tennessee Distribution
    Matthew Cole — 2 of 18 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Tennessee