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NPI 1386932333 · Edmond, OK · Retina Specialist (Ophthalmology) Physician
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Michael Hood is a retina specialist (ophthalmology) physician provider located in Edmond, Oklahoma. This profile covers 22 Medicare and 3 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 | Michael Hood |
| Address | 1851 S Kelly Ave Ste A |
| City | Edmond |
| State | OK |
| ZIP | 73013 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | July 12, 2011 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.5M |
| Medicaid | $0 |
This provider is effectively a Medicare-only biller at scale: lifetime Medicare revenue is $3.5M while Medicaid revenue is $0, and the NPI was enumerated 2011-07-12 (~15 years ago), indicating an established practice focused on the Medicare population rather than Medicaid. The absence of Medicaid billing suggests limited Medicaid participation or enrollment rather than a mixed-payer panel.
Revenue is highly concentrated in a small set of retina-related codes: the precomputed top 3 codes account for 84.9% of Medicare revenue, driven by J0178 ($2.1M, 60.2% of Medicare revenue), J2777 ($673.4K, 19.1%), and 67028 ($195.7K, 5.6%). This concentration indicates that a large majority of the practice’s Medicare dollars come from intravitreal biologic drugs and associated injection procedures.
The code mix and volumes point to a high-throughput retina injection practice model: J0178 (aflibercept) shows 3.1K claims and $685 avg paid/claim, and J2777 (faricimab) shows 23.2K claims with $29 avg paid/claim, while 67028 appears with 2.2K claims at $91 avg paid/claim. Substantial volumes of 92134 (3.4K claims, $91.6K revenue) and 92014 (1.7K claims, $133.9K revenue) support an integrated workflow of frequent retinal imaging and comprehensive follow-up visits that enable recurrent intravitreal therapy.
On competitive standing, the provider is a high-volume national participant for key retina services: J0178 ranks #168 of 3204 providers nationally (95th percentile; notably above typical national volume) and 67028 ranks #321 of 4255 (92th percentile; notably above typical national volume). J2777 is a more typical volume relative to peers (rank #434 of 2039, 79th percentile), so the practice’s dominance is strongest around aflibercept use and injection procedures.
Several codes are flagged as extreme outliers in national comparisons, indicating unusually high service volumes relative to peers: 92014 and 92134 both rank in the 99th percentile (described in the source as "extreme outlier, far above typical national volume"), and 99204 is reported as a 100th percentile extreme outlier. Those patterns suggest consistently high throughput of both diagnostic imaging and higher-complexity new-patient evaluations in addition to recurrent injection visits.
The practice also shows concentrated surgical retina capacity despite lower absolute revenue from these codes: 67145 is reported as $19.3K revenue and ranks #3 of 861 providers nationally (100th percentile; extreme outlier), and other surgical codes such as 67042 and 67113 are present. This combination of high-volume injections and standout surgical retina ranking indicates the provider likely offers both office-based injection clinics and referral-level surgical services.
Operationally, dependence on high-volume injectable drugs is a key revenue driver and a potential operational sensitivity: J0178 alone accounts for $2.1M (60.2% of Medicare revenue), so changes in drug mix, reimbursement, or utilization patterns could have outsized effects on total revenue. The practice appears optimized for recurring treatment regimens and associated imaging, which explains the high shares tied to biologic injections and retinal diagnostics.
Market positioning is that of a specialized retina practice with notable national-level intensity for several codes but very limited engagement with Medicaid. The combination of high national percentile ranks on injection, imaging, and select surgical codes positions the provider as a major retina services node for Medicare beneficiaries, while the $0 Medicaid revenue indicates little to no footprint in Medicaid-managed care or state-covered 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.
22 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 3,090 | $690 | $2.1M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 23,220 | $30 | $673.4K |
| 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. | 2,150 | $90 | $195.7K |
| 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… | 1,650 | $80 | $133.9K |
| 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. | 3,390 | $30 | $91.6K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 330 | $160 | $52K |
| 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 | $840 | $46.9K |
| J9035 | Injection, bevacizumab, 10 mg | 770 | $60 | $42.5K |
| 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… | 370 | $110 | $40.8K |
| 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… | 360 | $60 | $22.5K |
Showing 1–10 of 22
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 22 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
22 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 3 | 30 | 790 | $690 | $801.2K |
| J2777 | 10 | 20 | 23,040 | $30 | $781.1K |
| 67028 | 7 | 40 | 720 | $80 | $88.9K |
| J7312 | 3 | 10 | 340 | $150 | $54.8K |
| 67042 | 4 | 10 | 30 | $980 | $37.1K |
| J9035 | 7 | 30 | 330 | $50 | $23.5K |
| 67113 | 4 | 10 | 20 | $1,090 | $21.7K |
| 67036 | 8 | 10 | 20 | $900 | $19.9K |
| 92235 | 10 | 20 | 60 | $100 | $19.5K |
| 67108 | 8 | 10 | 20 | $1,020 | $19.5K |
Showing 1–10 of 22
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.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 10 | $0 | $0 |
| 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… | 10 | $0 | $0 |
| 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. | 30 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Oklahoma providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Oklahoma median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 13 | 10 | 850 | $60 | $102.1K |
| 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… | 88 | 100 | 120 | $90 | $67.6K |
| 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. | 23 | 30 | 190 | $20 | $30.9K |
Other providers in the same ZIP code as Michael Hood, ranked by combined Medicare and Medicaid revenue.
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