Loading...
NPI 1467621524 · Hattiesburg, MS · Retina Specialist (Ophthalmology) Physician
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Sean Allison is a retina specialist (ophthalmology) physician provider located in Hattiesburg, Mississippi. This profile covers 19 Medicare and 4 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 | Sean Allison |
| Address | 109 Millsaps Dr Ste B |
| City | Hattiesburg |
| State | MS |
| ZIP | 39402 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | February 22, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.7M |
| Medicaid | $33.4K |
SEAN ALLISON is effectively Medicare-dominant: lifetime Medicare revenue is reported as $1.7M versus Medicaid revenue of $33.4K, indicating the provider’s billing scale is overwhelmingly weighted toward the Medicare population rather than Medicaid. This payer mix suggests the practice’s clinical focus and patient panel are concentrated in older adults who are Medicare-eligible.
Medicare revenue is highly concentrated: the precomputed top 3 Medicare codes account for 87.9% of total Medicare revenue, driven chiefly by J0178 (61.6%, $1M), J2777 (19.6%, $332.3K), and 67028 (6.6%, $112K). Together these codes indicate that the practice’s primary revenue drivers are intravitreal biologic injections (aflibercept and faricimab) and isolated intravitreal injection procedures, consistent with a retina-focused service line.
The code mix and descriptions point to a retina-specialty operating model: high revenues from J0178 and J2777 paired with procedural billing for 67028 and ancillary retinal procedures (e.g., 67210, 67036) indicate outpatient injection-centric retina care rather than broad general ophthalmology. The presence of diagnostic imaging 92134 ($49.9K, 2.9% of Medicare revenue) further supports a workflow centered on retinal disease management that relies on imaging-guided treatment decisions.
One specific imaging metric stands out as an operational differentiator: 92134 ranks in the 95th percentile nationally and is labeled as notably above typical national volume, suggesting comparatively heavy use of computerized retinal imaging relative to peers. This elevated imaging volume likely supports frequent treatment decisions for retina conditions and may reflect a practice workflow optimized for retina diagnostics and monitoring.
Competitive standing across top Medicare procedural and drug codes is modest-to-strong but not dominant: J0178 ranks #789 of 3204 providers (75th percentile; typical, unremarkable volume), J2777 ranks #905 of 2039 providers (55th percentile; typical, unremarkable volume), and 67028 ranks #1175 of 4255 providers (72th percentile; typical, unremarkable volume). These percentiles indicate the provider maintains above-average but not top-tier national volume for the primary injection and procedure codes, with a notable exception for retinal imaging (92134) which is a relative outlier.
Medicaid billing is also concentrated: the precomputed top 3 Medicaid codes account for 85.1% of Medicaid revenue, with 92004 (30.7%, $10.2K), 92015 (29.4%, $9.8K), and 92014 (25.0%, $8.4K) together representing the bulk of the small Medicaid revenue base. The Medicaid mix is weighted toward comprehensive new and established ophthalmologic evaluations plus refractions, suggesting Medicaid encounters are more exam-focused than the injection-driven Medicare caseload.
State-level competitiveness on Medicaid appears modest: 92004 ranks #236 of 352 providers in-state (32th percentile), 92015 ranks #408 of 503 providers in-state (19th percentile), and 92014 ranks #329 of 420 providers in-state (21th percentile), all labeled as typical, unremarkable volume. These in-state percentiles imply the provider is a routine Medicaid participant without a dominant market share for these exam codes within Mississippi.
The provider has an established practice tenure: the NPI was enumerated on 2008-02-22 (~18 years ago) and the taxonomy is Retina Specialist (Ophthalmology) Physician. Combined with the concentration of Medicare revenue in retina injection and imaging codes, this tenure supports the interpretation of a long-standing, retina-focused outpatient practice serving primarily Medicare patients.
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 | 1,540 | $680 | $1M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 11,460 | $30 | $332.3K |
| 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. | 1,170 | $100 | $112K |
| 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. | 1,720 | $30 | $49.9K |
| 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… | 550 | $80 | $45.3K |
| 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… | 310 | $100 | $30K |
| J7999 | Compounded drug, not otherwise classified | 430 | $70 | $27.9K |
| 67210 | The provider destroys a lesion of the retina using a laser beam that heats up the tissue. | 50 | $390 | $17.6K |
| 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. | 20 | $640 | $10.9K |
| 92235 | The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken… | 50 | $100 | $5K |
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 | 4 | 20 | 670 | $680 | $990.1K |
| J2777 | 4 | 10 | 8,460 | $30 | $325.2K |
| 67028 | 11 | 30 | 600 | $80 | $107K |
| J7999 | 4 | 10 | 150 | $150 | $64.6K |
| 67036 | 11 | 10 | 20 | $890 | $25.7K |
| 92014 | 56 | 350 | 170 | $70 | $23K |
| 99214 | 1,241 | 4,110 | 170 | $70 | $21.9K |
| 67210 | 2 | 10 | 30 | $350 | $13.1K |
| 92235 | 11 | 20 | 70 | $90 | $12.1K |
| 99213 | 2,521 | 4,000 | 100 | $50 | $10.3K |
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.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 80 | $120 | $10.2K |
| 92015 | The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced. | 180 | $50 | $9.8K |
| 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… | 80 | $100 | $8.4K |
| 92340 | Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal | 220 | $20 | $5K |
How this provider's Medicaid billing volume and revenue compare to other Mississippi providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Mississippi median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 329 | 420 | 510 | $70 | $92.2K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 236 | 350 | 180 | $90 | $53.3K |
| 92015 | The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced. | 408 | 500 | 910 | $20 | $39.1K |
| 92340 | Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal | 287 | 390 | 740 | $20 | $25.9K |
Other providers in the same ZIP code as Sean Allison, ranked by combined Medicare and Medicaid revenue.
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.