Loading...
NPI 1326268475 · Plymouth Meeting, PA · Ophthalmology Physician
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Omesh Gupta is a ophthalmology physician provider located in Plymouth Meeting, Pennsylvania. This profile covers 23 Medicare and 1 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 | Omesh Gupta |
| Address | 4060 Butler Pike |
| City | Plymouth Meeting |
| State | PA |
| ZIP | 19462 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | April 30, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $7.1M |
| Medicaid | $80 |
OMESH GUPTA is listed as an Ophthalmology Physician in PLYMOUTH MEETING, PA with NPI enumerated 2007-04-30 (~19 years ago). Lifetime Medicare revenue is $7.1M versus lifetime Medicaid revenue of $77, indicating Medicare is overwhelmingly the commercial payer for this provider and Medicaid activity is effectively negligible in scale.
Revenue is highly concentrated in a small set of drug/injection codes: the precomputed top 3 Medicare codes by revenue account for 81.0% of the provider’s Medicare revenue. Those top three — J2778 ($2.1M, 30.2%), Q5128 ($1.8M, 25.7%), and J0178 ($1.8M, 25.1%) — dominate the payer mix and represent the principal revenue drivers.
The code mix shows a practice focused on high-volume intravitreal injections and related retina services rather than predominantly E&M office visits or general ophthalmology. High-volume drug codes J2778 (11.3K claims, $188 avg paid/claim) and Q5128 (8.4K claims, $216 avg paid/claim) together with procedural code 67028 (5K claims, $482.6K, 6.8%) and imaging 92134 (7.2K claims, $223.7K, 3.2%) point to repeated treatment courses (anti-VEGF therapy) and substantial diagnostic imaging throughput.
This provider shows national-level dominance on several high-revenue Medicare items: Q5128 ranks #1 of 373 providers nationally (100th percentile; extreme outlier) and J2778 ranks #8 of 1208 (99th percentile; extreme outlier). Imaging and intermediate exam volumes are also extreme outliers by national standards — 92134 ranks #6 of 26868 (100th percentile; extreme outlier) and 92012 ranks #3 of 17177 (100th percentile; extreme outlier) — signaling unusually large scale for both diagnostic imaging and intermediate-office visits in Medicare.
Not all top revenue codes are extreme outliers: J0178 (injection, aflibercept) generates $1.8M (25.1%) but ranks #290 of 3204 providers nationally (91th percentile; typical, unremarkable volume). This contrast indicates the provider’s exceptional standing is especially pronounced for ranibizumab and its biosimilar (J2778, Q5128) and for imaging/exam volumes, while aflibercept use is substantial but more typical compared with peers.
Medicaid activity is minimal and concentrated: lifetime Medicaid revenue is $77 and the precomputed top-3 Medicaid codes account for 100.0% of Medicaid revenue. The only listed Medicaid line is 92134 (12 claims, $72 revenue) which ranks #174 of 183 providers in-state (0th percentile; typical, unremarkable volume), reinforcing that this provider’s commercial footprint is essentially Medicare-centric.
A large share of Medicare dollars derives from injectable drug billing patterns and their payment differentials: J0178 shows a high avg paid/claim ($688) while J2778 and Q5128 show lower avg paid/claim amounts ($188 and $216 respectively). With J2778, Q5128 and J0178 together accounting for 81.0% of Medicare revenue, reimbursement shifts or drug mix changes for these agents would materially affect the practice’s revenue profile.
The combination of long tenure (NPI enumerated 2007-04-30 (~19 years ago)) and extremely high claim volumes for select codes (e.g., 11.3K claims for J2778, 8.4K for Q5128, 7.2K for 92134, 4.4K for 92012) indicates an established, high-throughput clinical operation focused on repeat-treatment retina services and diagnostics rather than episodic or low-volume care. For payers and analysts, this pattern signals predictable, recurring utilization concentrated in a small set of procedures and injectable agents.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
23 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J2778 | Injection, ranibizumab, 0.1 mg | 11,330 | $190 | $2.1M |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 8,410 | $220 | $1.8M |
| J0178 | Injection, aflibercept, 1 mg | 2,580 | $690 | $1.8M |
| 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. | 5,030 | $100 | $482.6K |
| 92012 | For 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… | 4,440 | $70 | $306K |
| 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. | 7,220 | $30 | $223.7K |
| 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… | 1,330 | $90 | $116.6K |
| 67042 | In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina… | 60 | $930 | $56.9K |
| 67036 | The 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. | 50 | $550 | $25.6K |
| 99204 | The 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… | 190 | $120 | $23.4K |
Showing 1–10 of 23
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 Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 23 | 140 | 830 | $690 | $865.1K |
| Q5128 | 1 | 20 | 3,830 | $220 | $838.7K |
| J2778 | 1 | 70 | 1,030 | $190 | $417.1K |
| 67028 | 1 | 180 | 600 | $90 | $87.5K |
| J7999 | 31 | 110 | 100 | $120 | $33.3K |
| 67042 | 3 | 50 | 20 | $1,100 | $31.9K |
| 67039 | 2 | 10 | 20 | $1,030 | $21.6K |
| 92014 | 25 | 1,570 | 130 | $80 | $21K |
| 66986 | 3 | 10 | 20 | $650 | $20.2K |
| 67036 | 3 | 30 | 20 | $830 | $19.9K |
Showing 1–10 of 23
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.
1 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. | 10 | $10 | $70 |
How this provider's Medicaid billing volume and revenue compare to other Pennsylvania providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Pennsylvania median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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. | 174 | 180 | 290 | $20 | $24.8K |
Other providers in the same ZIP code as Omesh Gupta, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Gemma Services | PA | Psychiatric Residential Treatment Facility | $0 | $23.8M |
| Access Services Inc | PA | Community/Behavioral Health Agency | $0 | $8.3M |
| Marc Spirn | PA | Ophthalmology Physician | $6.3M | $0 |
| Arunan Sivalingam | PA | Ophthalmology Physician | $6M | $0 |
| Sunir Garg | PA | Ophthalmology Physician | $6M | $0 |
| Carl Park | PA | Ophthalmology Physician | $5.5M | $0 |
| Ajay Kuriyan | PA | Ophthalmology Physician | $5.3M | $6.6K |
| Plymouth Community Ambulance Assn | PA | Land Ambulance | $903.5K | $4.3M |
| Sonia Mehta | PA | Ophthalmology Physician | $4.9M | $0 |
| Jason Hsu | PA | Ophthalmology Physician | $4.4M | $0 |
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.