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NPI 1457350670 · Bellevue, WA · Ophthalmology Physician
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Andrew Barloon is a ophthalmology physician provider located in Bellevue, Washington. This profile covers 17 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 | Andrew Barloon |
| Address | 1750 112th Ave Ne |
| City | Bellevue |
| State | WA |
| ZIP | 98004 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | July 19, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.7M |
| Medicaid | $20 |
This provider’s billed Medicare volume is concentrated in intravitreal drug therapy and retina diagnostics: J0178, J3490, and J2777 together account for the majority of Medicare receipts, and the precomputed top-three Medicare codes by revenue account for 76.4% of the provider’s total Medicare revenue. The presence of additional retina-focused codes such as J2781 and procedure 67028 alongside high-volume imaging 92134 supports an operational emphasis on medical retina care and in-office injection services rather than general comprehensive ophthalmology.
Medicare is the dominant payer by scale for this clinician: lifetime Medicare revenue is $2.7M versus just $24 in lifetime Medicaid revenue, so the practice is effectively single‑payer at scale with almost all billing activity tied to Medicare. The microscopic Medicaid total means Medicaid does not meaningfully contribute to the provider’s revenue mix and any payer negotiations should treat Medicare as the primary commercial lever.
Revenue concentration creates operational dependency on a small set of high-value services: the top three Medicare codes (J0178, J3490, J2777) drive 76.4% of Medicare dollars, indicating that changes in utilization or reimbursement for intravitreal drugs or unclassified drug billing could materially change overall revenue. That concentration is reinforced by presence of procedure code 67028 (injections) and multiple drug J‑codes in the top billers, pointing to a business model built around recurring injection encounters.
Competitive standing by code is mixed: for the leading drug J0178 the provider ranks #436 of 3204 nationally (86th percentile) which indicates an above‑average national footprint for aflibercept injections but not a top-tier national position. For pegcetacoplan J2781 the provider ranks #49 of 490 (90th percentile), showing relatively high national volume in that newer agent, while J2777 sits near the middle of its peer group (46th percentile), reflecting more typical utilization for faricimab.
Imaging utilization is a notable outlier: 92134 ranks #790 of 26868 nationally (97th percentile; labeled an "extreme outlier, far above typical national volume"), which means this provider performs OCT retinal imaging at far higher rates than almost all peers nationally. That pattern — high OCT volume plus frequent intravitreal drug administration — is consistent with an active medical retina practice managing conditions that require frequent imaging and injections.
Office evaluation-and-management codes show above-typical follow-up volume: 99213 is reported at a 96th percentile national rank and is described as "notably above typical national volume," indicating substantial office-based follow-up activity in addition to procedure-based care. By contrast, comprehensive new- and established-patient visit codes (92004, 92014, 99214) contribute only modestly to revenue, reinforcing the image of a procedure- and injection‑focused roster rather than a general comprehensive referral practice.
Medicaid activity is negligible and concentrated: the provider’s lifetime Medicaid revenue is $24 and the single Medicaid code listed, 92134, accounts for 100.0% of Medicaid revenue. In-state ranking for that Medicaid volume is #80 of 100 (20th percentile), signaling only modest participation in the state Medicaid program and no meaningful competitive standing in the Medicaid market.
The provider has long tenure in the NPI file, enumerated on 2005-07-19 (~21 years ago), which supports interpretation of the billing patterns as established practice behavior rather than a short-term anomaly. Given the long enrollment plus heavy Medicare concentration in intravitreal therapies and OCT imaging, analysts should treat these patterns as stable service-line characteristics when benchmarking or forecasting contract impact.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
17 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,200 | $690 | $1.5M |
| J3490 | Unclassified drugs | 160 | $1,940 | $316.9K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 8,820 | $30 | $255.8K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 1,490 | $120 | $178.2K |
| 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. | 1,600 | $100 | $162.7K |
| 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. | 2,300 | $30 | $71.2K |
| 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… | 520 | $100 | $49K |
| 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… | 660 | $70 | $43.2K |
| 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… | 380 | $100 | $36.4K |
| J7999 | Compounded drug, not otherwise classified | 400 | $70 | $29K |
Showing 1–10 of 17
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 17 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
17 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J2777 | 33 | 50 | 12,780 | $30 | $599.7K |
| J0178 | 10 | 90 | 470 | $680 | $597.2K |
| Q5128 | 13 | 10 | 520 | $220 | $136.6K |
| J2781 | 1 | 10 | 650 | $120 | $88.6K |
| 67028 | 19 | 110 | 550 | $90 | $72.9K |
| J3490 | 12 | 70 | 70 | $50 | $51.2K |
| 67042 | 20 | 40 | 30 | $1,190 | $39.2K |
| 92014 | 81 | 790 | 110 | $80 | $16.8K |
| J7999 | 6 | 70 | 150 | $70 | $15.9K |
| 99214 | 1,108 | 10,860 | 100 | $80 | $13.6K |
Showing 1–10 of 17
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. | 20 | $1 | $20 |
How this provider's Medicaid billing volume and revenue compare to other Washington providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Washington 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. | 80 | 100 | 240 | $10 | $22.2K |
Other providers in the same ZIP code as Andrew Barloon, ranked by combined Medicare and Medicaid revenue.
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