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NPI 1427054808 · Lexington, KY · Retina Specialist (Ophthalmology) Physician
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Miguel Busquets is a retina specialist (ophthalmology) physician provider located in Lexington, Kentucky. This profile covers 19 Medicare and 2 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 | Miguel Busquets |
| Address | 120 N Eagle Creek Dr Ste 500 |
| City | Lexington |
| State | KY |
| ZIP | 40509 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | June 22, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.4M |
| Medicaid | $54.4K |
MIGUEL BUSQUETS is a retina specialist (Ophthalmology) with an NPI enumerated 2005-06-22 (~21 years ago). The provider reports $2.4M in total Medicare revenue and $54.4K in total Medicaid revenue, indicating a practice that is heavily Medicare-weighted in scale and reimbursement activity rather than Medicaid-driven services.
Medicare revenue is highly concentrated: the provider's top three Medicare codes (J0178, J2777, 67028) account for 86.4% of total Medicare revenue. J0178 alone represents 68.6% of Medicare revenue, J2777 13.0%, and 67028 4.8%, signaling that intravitreal biologic therapy is the primary revenue engine on the Medicare side.
The code mix and billed services point to a retina-focused clinical model centered on intravitreal injections and retinal imaging. High-revenue drug codes (J0178 aflibercept, J2777 faricimab, and J2778 ranibizumab) combined with procedural codes for intravitreal injection (67028) and retinal diagnostics (92134) are consistent with outpatient medical retina care delivering frequent anti-VEGF/anti–angiogenic injections and routine retinal monitoring. Surgical retina codes (67036, 67041) appear intermittently, indicating occasional operative cases in addition to the injection/imaging workload.
On Medicare competitive standing, the provider ranks well above the median nationally for the largest billed drug: J0178 ranks #352 of 3204 (89th percentile; typical, unremarkable volume). This places the provider in an above-median national position for aflibercept administration even as the dataset characterizes the volume as "typical, unremarkable." Conversely, several other Medicare codes are described as typical and occupy middle-to-lower national percentiles, indicating focused strength on a narrow set of therapy codes rather than broad high-volume practice across many codes.
Retinal imaging (92134) is a notable outlier in national context: the provider's Medicare volume for 92134 ranks #1257 of 26868 (95th percentile) and is labeled "notably above typical national volume." This suggests stronger-than-typical utilization of posterior-segment diagnostic imaging relative to peers, supporting the pattern of frequent monitoring of retinal disease that accompanies high anti-VEGF injection volumes. Medicaid billing also includes 92134, confirming imaging is a paired component on both payers.
Medicaid activity is very small relative to Medicare and tightly concentrated: the provider reports $54.4K in total Medicaid revenue with the top Medicaid codes accounting for 100.0% of that revenue. Within Medicaid, 67028 represents 75.7% of Medicaid revenue and 92134 represents 24.3%, showing that intravitreal injection procedures and retinal imaging fully explain the provider's Medicaid billing. This underlines the provider's effective single-payer scale (Medicare-dominant) in terms of revenue.
Competitive standing within the state Medicaid market is modest. For Medicaid 67028 the provider ranks #18 of 31 in-state (43th percentile; typical, unremarkable volume) and for Medicaid 92134 ranks #26 of 74 in-state (66th percentile; typical, unremarkable volume), indicating participation in the state Medicaid network but not a dominant position among in-state retina providers for these services.
There are a few additional signal points in the Medicare mix worth noting: J3490 (unclassified drugs) appears at a very low national rank (#2724 of 2838, 3th percentile; typical, unremarkable volume), while J3590 (unclassified biologics) sits at a moderate national rank (#225 of 631, 64th percentile; typical, unremarkable volume). Together with the dominance of labeled anti-VEGF codes, these low-frequency unclassified drug entries suggest most biologic drug revenue is captured under the main anti-VEGF codes rather than through miscellaneous drug coding.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
19 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,410 | $690 | $1.7M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 10,800 | $30 | $313.2K |
| 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. | 1,330 | $90 | $115.6K |
| J2778 | Injection, ranibizumab, 0.1 mg | 490 | $180 | $88.5K |
| 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. | 1,770 | $30 | $46K |
| J3590 | Unclassified biologics | 150 | $280 | $41.7K |
| J3490 | Unclassified drugs | 20 | $1,730 | $27.7K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 150 | $160 | $24.5K |
| 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… | 420 | $60 | $24.2K |
| 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… | 220 | $90 | $19.1K |
Showing 1–10 of 19
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 19 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
19 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 9 | 40 | 870 | $690 | $858.5K |
| J2777 | 16 | 30 | 11,040 | $30 | $399.1K |
| J2778 | 12 | 20 | 700 | $180 | $148.3K |
| 67028 | 13 | 50 | 650 | $90 | $72.9K |
| J7312 | 9 | 10 | 190 | $160 | $43.9K |
| 67036 | 6 | 20 | 20 | $910 | $28.1K |
| J3490 | 14 | 10 | 50 | $370 | $27.2K |
| 67041 | 8 | 10 | 20 | $1,020 | $24.5K |
| J3590 | 21 | 40 | 160 | $60 | $17K |
| 99214 | 2,077 | 7,230 | 110 | $70 | $14.1K |
Showing 1–10 of 19
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.
2 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. | 280 | $150 | $41.1K |
| 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. | 460 | $30 | $13.2K |
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky median
2 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. | 18 | 30 | 350 | $70 | $165.3K |
| 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. | 26 | 70 | 210 | $20 | $29.2K |
Other providers in the same ZIP code as Miguel Busquets, ranked by combined Medicare and Medicaid revenue.
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