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NPI 1568529105 · Provo, UT · Retina Specialist (Ophthalmology) Physician
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Richard Corey is a retina specialist (ophthalmology) physician provider located in Provo, Utah. 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 | Richard Corey |
| Address | 1055 N 300 W Ste 500 |
| City | Provo |
| State | UT |
| ZIP | 84604 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | January 2, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3M |
| Medicaid | $50.1K |
This provider’s billing is overwhelmingly Medicare-centered: lifetime Medicare revenue is $3M compared with Medicaid revenue of $50.1K, indicating an effectively Medicare-dominant practice where Medicaid is a very small share of total reported payer activity. The magnitude gap suggests the provider’s operational and revenue focus is on fee-for-service Medicare patients rather than Medicaid panels or safety-net care.
Medicare revenue is highly concentrated in a small set of high-cost drug and office-visit codes: the top three Medicare codes (J0178, J3490, 99214) account for 81.0% of this provider’s total Medicare revenue. In particular J0178 (aflibercept) alone represents $1.7M and 56.5% of Medicare revenue, while J3490 contributes $587.2K (19.4%) and 99214 contributes $157.2K (5.2%), signaling that intravitreal therapeutics plus associated E/M visits drive the practice’s Medicare economics.
Clinical/service-line mix on Medicare points to a retina-centric injection practice with supplemental surgical and imaging activity: large volumes of J0178 (2.5K claims, $691 avg paid/claim, $1.7M revenue) and measurable use of J7312 (616 claims, $97.9K) indicate regular intravitreal pharmacologic treatment and implant use, while 92134 (2.2K claims, $64.1K) shows substantial retinal imaging throughput. Surgical retina procedures are present but account for much smaller revenue shares (for example, 67028 contributes $131.7K / 4.3% and 67041 contributes $40.6K / 1.3%), consistent with a practice that performs injections and diagnostics as primary revenue drivers and surgery episodically.
On competitive standing for core Medicare codes, the provider posts above-typical national ranks for drug administration volumes but an exceptional E/M footprint: J0178 ranks #332 of 3204 nationally (90th percentile; typical, unremarkable volume for this code) and J3490 ranks #219 of 2838 (92th percentile; typical, unremarkable), indicating materially above-average injectable drug billing, while 99214 ranks #1953 of 479517 (100th percentile; extreme outlier, far above typical national volume for this code), highlighting unusually high E/M claim volume versus national peers.
Medicaid billing is narrowly concentrated in routine office visits and comprehensive exams: the top three Medicaid codes (99213, 99214, 92014) account for 97.6% of the provider’s total Medicaid revenue. Specifically, 99213 contributes $24.9K (49.4%), 99214 contributes $18.8K (37.3%), and 92014 contributes $5.5K (10.9%), indicating that Medicaid activity is primarily low- to moderate-complexity outpatient E/M and exam services rather than drug administration or procedural care.
Relative to in-state peers, the provider is a modest Medicaid participant: 99213 ranks #1226 of 1355 in-state (7th percentile; typical, unremarkable volume for this code) and 92014 ranks #142 of 155 (6th percentile), placing the provider well below most state peers on Medicaid volume. This contrast—high Medicare specialty drug volume versus low Medicaid visit volume—suggests limited Medicaid market penetration or selective Medicaid participation for this retina specialist.
Several individual codes are flagged as statistical outliers or notably above typical volume and underscore specialty concentration: 99214 on Medicare is labeled an "extreme outlier, far above typical national volume for this code," while J7312 (dexamethasone implant) is "notably above typical national volume for this code" (rank #23 of 492, 95th percentile), and 92134 is also "notably above typical national volume" (rank #856 of 26868, 97th percentile). These flagged positions support the interpretation that the practice has unusually high encounter and certain implant/drug-treatment activity compared with national peers.
The provider has sustained tenure in the marketplace, with NPI enumerated 2007-01-02 (~19 years ago), which is consistent with a long-established retina practice likely supported by stable referral patterns and an entrenched patient panel; coupled with the concentration on high-cost intravitreal therapies, this tenure helps explain consistent Medicare drug and E/M volumes over time.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
20 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,470 | $690 | $1.7M |
| J3490 | Unclassified drugs | 290 | $2,010 | $587.2K |
| 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… | 1,810 | $90 | $157.2K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 1,170 | $120 | $140.4K |
| 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. | 1,420 | $90 | $131.7K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 620 | $160 | $97.9K |
| 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 | $64.1K |
| 67041 | In this procedure, the provider removes scar tissue from the retinal membrane that obscures vision. He removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical… | 50 | $830 | $40.6K |
| 99204 | The provider sees a new 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 provider… | 180 | $110 | $19.4K |
| 92202 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 1,500 | $10 | $16.5K |
Showing 1–10 of 20
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 20 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
20 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 6 | 40 | 620 | $690 | $683.2K |
| J3490 | 3 | 30 | 80 | $1,690 | $199.5K |
| J2781 | 6 | 20 | 960 | $120 | $126.6K |
| 67028 | 11 | 60 | 440 | $90 | $61.7K |
| J7312 | 1 | 10 | 340 | $160 | $52.7K |
| 67041 | 1 | 10 | 20 | $1,040 | $28.2K |
| 67042 | 7 | 20 | 20 | $1,100 | $26.3K |
| 67036 | 5 | 20 | 20 | $1,010 | $24.2K |
| 67113 | 4 | 10 | 20 | $1,170 | $20K |
| 67108 | 7 | 10 | 20 | $1,090 | $18.6K |
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.
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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 |
|---|---|---|---|---|
| 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… | 10 | $1,780 | $24.9K |
| 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… | 70 | $290 | $18.8K |
| 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… | 10 | $420 | $5.5K |
| 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. | 400 | $1 | $1.2K |
| 92201 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 10 | $0 | $0 |
| 92202 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 50 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Utah providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Utah 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… | 906 | 1,340 | 200 | $80 | $144K |
| 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… | 1,226 | 1,360 | 190 | $70 | $125K |
| 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… | 142 | 160 | 120 | $100 | $55.5K |
| 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. | 12 | 20 | 430 | $30 | $36K |
| 92201 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 4 | 10 | 30 | $10 | $1.8K |
| 92202 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 4 | 10 | 120 | $10 | $1.1K |
Other providers in the same ZIP code as Richard Corey, ranked by combined Medicare and Medicaid revenue.
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