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NPI 1528007101 · Beachwood, OH · Retina Specialist (Ophthalmology) Physician
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Joseph Coney is a retina specialist (ophthalmology) physician provider located in Beachwood, Ohio. This profile covers 18 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 | Joseph Coney |
| Address | 3401 Enterprise Pkwy |
| City | Beachwood |
| State | OH |
| ZIP | 44122 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | June 6, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.2M |
| Medicaid | $140 |
This provider’s billing is overwhelmingly Medicare-driven: lifetime Medicare revenue is $3.2M compared with just $138 in Medicaid receipts, so the practice is effectively single-payer (Medicare) in scale. Medicaid activity is negligible in dollar terms and does not materially contribute to the practice’s revenue base.
Revenue concentration within Medicare is high: the precomputed top three Medicare codes account for 77.7% of the provider’s Medicare revenue, driven primarily by intravitreal drug administrations (J0178, J2777) and a newer complement inhibitor (J2781). This code mix points to a service-line centered on in-office retinal drug delivery rather than broad primary ophthalmology care.
Medicaid billing is narrowly focused and minimal: 100.0% of the provider’s Medicaid revenue is from 92134 (retinal imaging) totaling $144, and the provider ranks #94 of 95 in-state for that code (0th percentile; typical, unremarkable volume). This indicates very limited participation in Medicaid patients and no diversified Medicaid service lines.
On competitive standing for key drug codes, the provider posts above-median to high-percentile placements but the export labels indicate routine volumes: J0178 ranks #584 of 3204 (82th percentile; typical, unremarkable volume), J2777 ranks #249 of 2039 (88th percentile; typical, unremarkable volume), and J2781 ranks #34 of 490 (93th percentile; typical, unremarkable volume). In plain terms, the provider is a solid regional contributor for these intravitreal drugs but not an outlier national dominator in most drug categories.
There are notable statistical outliers in diagnostic/E&M and imaging activity: 92012 ranks #197 of 17177 (99th percentile; extreme outlier, far above typical national volume) and 92134 ranks #1015 of 26868 (96th percentile; notably above typical national volume). The combination of very high 92012 volume and elevated retinal imaging (92134) reinforces that the practice sees a large established-patient ophthalmology caseload and invests in retina diagnostics.
Procedural mix shows frequent in-office injections with limited surgical retina volume: 67028 (intravitreal injection) generated $150.5K (4.7% of Medicare revenue) across 1.7K claims, while 67042 (vitrectomy/ILM peel) appears only 11 times for $9.4K (0.3% of Medicare revenue). This pattern is consistent with a retina specialist practice that emphasizes repeat, office-based therapeutics over operating-room procedures.
Drug payment levels amplify revenue concentration: high-revenue drug lines include J0178 at $691 avg paid/claim producing $1.3M (41.0% of Medicare revenue) and J2777 producing $962.2K (30.2%), while J3490 (unclassified drugs) shows 99 claims at $1768 avg paid/claim for $175K (5.5%). These per-claim payment figures indicate that a relatively small number of drug administrations account for a large share of Medicare dollars.
The provider’s tenure is long-standing—NPI enumerated 2006-06-06 (~20 years ago)—which, combined with concentrated Medicare drug and imaging billing and minimal Medicaid revenue, suggests an established retina specialty practice focused on Medicare beneficiaries and office-based retinal therapeutics. This profile should inform payer contracting and utilization management discussions around high-cost intravitreal medications and frequent follow-up visits.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
18 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 1,890 | $690 | $1.3M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 33,180 | $30 | $962.2K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 1,710 | $120 | $205.2K |
| J3490 | Unclassified drugs | 100 | $1,770 | $175K |
| 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. | 1,650 | $90 | $150.5K |
| 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… | 1,430 | $60 | $87.4K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 520 | $160 | $82.4K |
| 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. | 2,020 | $30 | $56.7K |
| J2778 | Injection, ranibizumab, 0.1 mg | 300 | $190 | $54.9K |
| 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… | 590 | $80 | $48.2K |
Showing 1–10 of 18
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 18 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
18 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 21 | 100 | 840 | $680 | $729K |
| J2777 | 2 | 70 | 9,480 | $30 | $353.3K |
| J2781 | 4 | 20 | 1,040 | $120 | $152.4K |
| J2778 | 10 | 20 | 370 | $180 | $73.1K |
| J3490 | 29 | 50 | 100 | $560 | $73.1K |
| 67028 | 16 | 150 | 470 | $90 | $64K |
| J7312 | 1 | 20 | 240 | $160 | $41.7K |
| J3590 | 53 | 100 | 200 | $100 | $30K |
| 67042 | 49 | 50 | 20 | $960 | $29.7K |
| 92014 | 77 | 1,390 | 100 | $70 | $12.9K |
Showing 1–10 of 18
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 | $140 |
How this provider's Medicaid billing volume and revenue compare to other Ohio providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Ohio 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. | 94 | 100 | 420 | $20 | $55.8K |
Other providers in the same ZIP code as Joseph Coney, ranked by combined Medicare and Medicaid revenue.
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