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NPI 1528385598 · Gillette, WY · Rheumatology Physician
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Horng-chyi Lai is a rheumatology physician provider located in Gillette, Wyoming. This profile covers 20 Medicare and 6 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 | Horng-chyi Lai |
| Address | 469 Highway 50 |
| City | Gillette |
| State | WY |
| ZIP | 82718 |
| Taxonomy | Rheumatology Physician |
| NPI Enumerated | April 29, 2010 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.4M |
| Medicaid | $0 |
This provider is effectively a single-payer Medicare biller at the scale shown: lifetime Medicare revenue is $1.4M while Medicaid revenue is $0, so all recorded public-payer billing is concentrated in Medicare. The absence of Medicaid activity indicates payer mix is heavily weighted to fee-for-service Medicare rather than state Medicaid programs.
Revenue concentration is high: the precomputed top-3 Medicare codes by revenue account for 50.4% of this provider's total Medicare revenue, driven by J3262 ($258.6K, 17.6%), J1745 ($254.3K, 17.3%), and J0129 ($226.9K, 15.5%). This concentration shows that a small set of high-cost biologic drug injections dominates the provider’s Medicare revenue base.
The CPT/HCPCS mix and code descriptions indicate an infusion- and biologic-focused rheumatology practice: primary revenue drivers are injectable biologics used in rheumatologic care (J3262 tocilizumab, J1745 infliximab, J0129 abatacept) and supporting infusion administration codes such as 96413, 96365, and 96415. Presence of both high-revenue drug J-codes and infusion/chemotherapy administration CPTs suggests the practice provides onsite infusion services rather than only office-based prescriptions.
Competitive standing is mixed across specific agents: the provider ranks relatively high for infliximab (J1745 ranks #99 of 1352 providers nationally, 93th percentile), while tocilizumab (J3262 ranks #218 of 618, 65th percentile) and abatacept (J0129 ranks #733 of 1221, 40th percentile) are at or below median national volumes for those drugs. In short, the provider is a meaningful regional participant for select biologics (notably infliximab) but not a dominant national leader across all major agents.
Several infusion/administration codes are statistical outliers versus national peers: 96415 (add-on infusion hour) ranks #203 of 4959 providers nationally at the 96th percentile and 96413 (initial infusion) ranks #628 of 7514 at the 92th percentile, both described as above-typical volumes. Those high percentiles imply longer or more frequent infusion sessions than typical peers, consistent with a practice that schedules extended biologic infusions.
Clinical visit revenue is a small share of the Medicare mix compared with drug and infusion billing: 99214 generated $46K (3.1% of Medicare revenue), 99215 $14K (1.0%), and 99213 $4.1K (0.3%). This pattern reinforces that drug administration and infusion services—not office E&M—are the principal revenue drivers for Medicare.
Despite the biologic focus, the provider shows typical national volumes on many commonly billed rheumatology agents: J9312 rituximab ($214K, 14.6%) ranks #143 of 317 (55th percentile) and J1602 golimumab ($196.5K, 13.4%) ranks #351 of 1041 (66th percentile), indicating steady but not extreme participation across multiple biologic therapies. The presence of multiple mid-ranked biologics suggests a diversified therapeutic mix within the infusion service line.
Operational sensitivity should be noted: with top biologic J-codes concentrated and accounting for half of Medicare revenue (top-3 = 50.4%), the practice’s financial performance could be meaningfully affected by reimbursement changes, formulary shifts, or supply/pricing dynamics for those specific drugs. That concentration highlights business risk tied to a small set of high-cost medications even as tenure (NPI enumerated 2010-04-29 (~16 years ago)) indicates an established billing history in Medicare.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
20 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J3262 | Injection, tocilizumab, 1 mg | 51,720 | $10 | $258.6K |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 9,780 | $30 | $254.3K |
| J0129 | Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | 6,880 | $30 | $226.9K |
| J9312 | Injection, rituximab, 10 mg | 3,450 | $60 | $214K |
| J1602 | Injection, golimumab, 1 mg, for intravenous use | 17,870 | $10 | $196.5K |
| J1306 | Injection, inclisiran, 1 mg | 15,050 | $10 | $135.5K |
| 96413 | Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These… | 520 | $100 | $51.3K |
| 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… | 510 | $90 | $46K |
| J0897 | Injection, denosumab, 1 mg | 1,980 | $20 | $35.6K |
| 99215 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the… | 100 | $140 | $14K |
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How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 20 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
20 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0897 | 3 | 50 | 1,800 | $20 | $51.1K |
| 96413 | 1 | 10 | 150 | $100 | $22.9K |
| 99214 | 125 | 780 | 100 | $80 | $14.8K |
| 96365 | 4 | 10 | 220 | $50 | $13.4K |
| 99213 | 931 | 850 | 110 | $60 | $9.9K |
| 99215 | 181 | 220 | 40 | $120 | $8.3K |
| 99205 | 101 | 80 | 20 | $150 | $6.3K |
| 20610 | 143 | 120 | 60 | $50 | $3.8K |
| 96415 | 1 | 10 | 100 | $20 | $2.6K |
| J2930 | 1 | 10 | 520 | $1 | $2.1K |
Showing 1–10 of 20
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.
6 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 20 | $0 | $0 |
| 96365 | The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease. | 20 | $0 | $0 |
| 96413 | Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These… | 70 | $0 | $0 |
| 96415 | In this add on procedure, the provider continues administration of a chemotherapy drug into a vein using an infusion technique. He uses this code to report each additional hour of infusion beyond the… | 60 | $0 | $0 |
| 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… | 390 | $0 | $0 |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 70 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Wyoming providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Wyoming median
6 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 113 | 220 | 400 | $50 | $79.3K |
| 96365 | The provider administers the initial intravenous infusion of a medication or other substance for a period up to one hour to prevent, treat, or diagnose a condition or disease. | 5 | 10 | 40 | $40 | $2.6K |
| 96413 | Chemotherapy is a therapeutic procedure used for the treatment of cancer via the use of chemical agents. These chemical agents (drugs) work on the cancerous cells of the body to destroy them. These… | 1 | 10 | 70 | $30 | $2.2K |
| 36415 | In this procedure, the provider inserts a needle into a vein to collect a blood sample. | 43 | 50 | 140 | $1 | $820 |
| 96415 | In this add on procedure, the provider continues administration of a chemotherapy drug into a vein using an infusion technique. He uses this code to report each additional hour of infusion beyond the… | 1 | 10 | 60 | $0 | $0 |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg | 1 | 10 | 70 | $0 | $0 |
Other providers in the same ZIP code as Horng-chyi Lai, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Sol Domus, Inc. | WY | Developmentally Disabled Services Day Training Agency | $0 | $8.8M |
| Wyoming Home Health Inc | WY | Home Health Agency | $0 | $1.7M |
| Heather Voigt | WY | Case Management Agency | $0 | $926.8K |
| Atlas Therapy LLC | WY | Mental Health Counselor | $0 | $755K |
| Andrea Snyder | WY | Case Manager/Care Coordinator | $0 | $300.8K |
| Children's Developmental Services Of Campbell County | WY | Clinic/Center | $0 | $281.3K |
| Meadowlark Counseling | WY | Psychologist | $0 | $274.4K |
| Lukasz Kiljanek | WY | Nephrology Physician | $210.9K | $0 |
| County Of Campbell | WY | Public Health or Welfare Agency | $11.4K | $194.4K |
| Momentum Physical Therapy | WY | Physical Therapy Clinic/Center | $0 | $205.5K |
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