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NPI 1528064219 · Louisville, KY · Retina Specialist (Ophthalmology) Physician
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Thomas Stone is a retina specialist (ophthalmology) physician provider located in Louisville, Kentucky. This profile covers 23 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 | Thomas Stone |
| Address | 6450 Dutchmans Pkwy |
| City | Louisville |
| State | KY |
| ZIP | 40205 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | June 27, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.5M |
| Medicaid | $520 |
This provider’s revenue is overwhelmingly Medicare-driven: total Medicare revenue is $2.5M versus total Medicaid revenue of $520, so the practice is effectively Medicare-dominant with only a trace Medicaid footprint. The Medicaid total is composed entirely of 92134 billing, so commercially and public-payer exposure beyond Medicare is minimal.
Revenue concentration on Medicare is pronounced: precomputed data show the top 3 Medicare codes by revenue account for 75.5% of this provider's total Medicare revenue. Those top three codes are high-cost intravitreal biologic injections (J0178, J2777, J2778), indicating that most Medicare dollars flow from medication administration rather than routine office visits or ancillary testing.
The code mix and volumes identify a retina-focused, injection-heavy practice model: J0178 (aflibercept) alone accounts for $1.4M and 2K claims, and J2777 (faricimab) and J2778 (ranibizumab) are the next largest contributors. Combined with substantial OCT imaging (92134), the pattern is consistent with regular intravitreal therapy and disease monitoring workflows central to retina specialty care.
Imaging intensity is a notable strength: 92134 has 2.2K claims and $59.6K revenue for Medicare and ranks #858 of 26868 providers nationally (97th percentile; notably above typical national volume). High OCT volume relative to national peers supports a case mix that requires frequent anatomic monitoring and likely drives recurring follow-up visits tied to injection cycles.
Competitive standing on the principal drug is modest nationally: J0178 ranks #541 of 3204 providers (83th percentile; typical, unremarkable volume), while J2777 and J2778 sit in middle percentiles (58th and 54th respectively; both labeled typical, unremarkable volume). In short, the provider is an active participant in intravitreal biologic administration but does not appear as an extreme outlier or dominant national provider for those drugs.
Surgical-retina services are present but secondary to injections: codes such as 67036 (44 claims, $27.9K, rank #101 of 832, 88th percentile; typical, unremarkable volume) and 67041 (35 claims, $27.2K, rank #60 of 461, 87th percentile; typical, unremarkable volume) indicate some vitrectomy/retinal surgery activity. These procedures contribute meaningful clinical capability and revenue diversification, but they represent a much smaller share of total Medicare revenue than injectable therapies.
Medicaid engagement is minimal and localized to imaging: Medicaid revenue is $528 with 16 claims of 92134 accounting for 100.0% of the provider’s Medicaid billing; in-state rank for that code is #66 of 74 providers (8th percentile; typical, unremarkable volume). This suggests limited participation or low Medicaid patient volume, so Medicaid policy changes or state-level network decisions are unlikely to materially affect overall revenue.
The provider has long tenure on file—NPI enumerated 2005-06-27 (~21 years ago)—which, together with the sustained patterns of injection and high OCT volume, implies an established retina practice with consistent clinical workflows centered on intravitreal therapy and retinal imaging.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
23 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 1,990 | $690 | $1.4M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 12,480 | $30 | $361.9K |
| J2778 | Injection, ranibizumab, 0.1 mg | 730 | $180 | $134.3K |
| 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. | 1,300 | $90 | $115.8K |
| J3490 | Unclassified drugs | 50 | $1,640 | $88.8K |
| 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. | 2,210 | $30 | $59.6K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 480 | $120 | $57.7K |
| 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… | 610 | $90 | $56K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 290 | $160 | $46.5K |
| 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… | 610 | $60 | $35.8K |
Showing 1–10 of 23
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 23 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
23 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 14 | 40 | 870 | $690 | $858.5K |
| J2777 | 12 | 30 | 11,040 | $30 | $399.1K |
| J2778 | 8 | 20 | 700 | $180 | $148.3K |
| 67028 | 14 | 50 | 650 | $90 | $72.9K |
| J2781 | 2 | 10 | 380 | $120 | $48.4K |
| J7312 | 5 | 10 | 190 | $160 | $43.9K |
| 67036 | 5 | 20 | 20 | $910 | $28.1K |
| J3490 | 6 | 10 | 50 | $370 | $27.2K |
| 67041 | 2 | 10 | 20 | $1,020 | $24.5K |
| 67042 | 4 | 10 | 20 | $1,170 | $23.4K |
Showing 1–10 of 23
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 | $30 | $530 |
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
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. | 66 | 70 | 210 | $20 | $29.2K |
Other providers in the same ZIP code as Thomas Stone, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Dreams With Wings, Inc | KY | Behavior Analyst | $0 | $20.1M |
| The Princecare Group | KY | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | $0 | $19M |
| Hosparus Inc. | KY | Community Based Hospice Care Agency | $0 | $10.1M |
| Dental Surgicenter Of Louisville LLC | KY | Ambulatory Surgical Clinic/Center | $0 | $8.4M |
| Norton Hospitals Inc | KY | Land Ambulance | $791.2K | $77.1K |
| Andrew West | KY | MOHS-Micrographic Surgery Physician | $713.9K | $0 |
| Tariq Muhammad | KY | Nephrology Physician | $245.5K | $189K |
| Casey Johnson | KY | Ophthalmology Physician | $284.1K | $0 |
| Ramsey Nassar | KY | Nephrology Physician | $253.9K | $0 |
| Boutros El-haddad | KY | Nephrology Physician | $247.3K | $0 |
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