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NPI 1588750178 · Jackson, MS · Retina Specialist (Ophthalmology) Physician
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Michael Borne is a retina specialist (ophthalmology) physician provider located in Jackson, Mississippi. This profile covers 21 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 | Michael Borne |
| Address | 1200 N State St |
| City | Jackson |
| State | MS |
| ZIP | 39202 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | October 4, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.5M |
| Medicaid | $1.8K |
This provider reports $4.5M in lifetime Medicare revenue and $1.8K in lifetime Medicaid revenue, and has been NPI-enumerated since 2006-10-04 (~20 years ago). The distribution of billed services and the large Medicare scale indicate an established retina subspecialty practice with a long-tenured billing history in the Medicare program.
Revenue is highly concentrated in a small set of injection and retina-imaging services: the precomputed top 3 Medicare codes account for 86.4% of the provider's total Medicare revenue, and a single Medicaid code accounts for 100.0% of Medicaid revenue. That concentration shows the practice’s financial dependence on a few high-revenue clinical lines rather than a broad mix of general ophthalmology procedures.
The provider is an extremely high-volume user of aflibercept injections: J0178 appears 5K times for $3.4M in Medicare revenue (76.4% of Medicare revenue) and ranks 26 of 3204 providers nationally (99th percentile; extreme outlier). This positioning indicates the practice’s core service is recurrent intravitreal anti-VEGF therapy delivered at scale, making drug administration the primary revenue engine.
Imaging and procedural follow-up volumes are also outsized: 92134 has 3.4K Medicare claims for $80.6K (1.8% of Medicare revenue) and ranks 259 of 26868 providers nationally (99th percentile; extreme outlier), while 67028 shows 2.5K Medicare claims for $209.6K (4.7% of Medicare revenue) and ranks 172 of 4255 (96th percentile; notably above typical). Together these codes reflect a workflow that couples frequent intravitreal injections with high-throughput retinal imaging and same-day or separate vitreous injection procedures.
The provider’s mix of injectable biologics and biosimilars is broad: Medicare billing includes J0178 (aflibercept, avg paid/claim $689), J2778 (ranibizumab, avg paid/claim $184), Q5124 (ranibizumab biosimilar, avg paid/claim $175), Q5128 (another ranibizumab biosimilar, avg paid/claim $216), and J2777 (faricimab, avg paid/claim $29). This spread of branded agents, newer agents, and biosimilars suggests the practice administers multiple anti-VEGF options rather than relying on a single product, which has implications for drug procurement, inventory management, and formulary negotiations.
Office evaluation-and-management and ancillary billing patterns support frequent, routine patient follow-up: 99213 appears 1.2K times for $61.8K and ranks 3740 of 457151 providers nationally (99th percentile; extreme outlier), and 92134’s high rank reinforces repeated monitoring encounters. These data are consistent with chronic disease management for retinal conditions requiring serial visits and imaging.
Despite the sizable Medicare footprint, the provider has a negligible Medicaid presence: total Medicaid revenue is $1.8K, entirely from 92134 (52 claims, 100.0% of Medicaid revenue), with that code ranking 24 of 41 providers in-state (43rd percentile; typical). In practical terms this provider functions as effectively single-payer (Medicare) for major revenue-generating services and is not a major Medicaid retinal imaging provider in Mississippi.
From a competitive standpoint the provider is a nationally prominent, high-volume injector for key ophthalmic biologic therapy—J0178 is classified an "extreme outlier" nationally—while also ranking extremely high for retinal imaging (92134) and notably above typical for 67028. Those rank positions indicate a dominant role in the Medicare market for intravitreal therapy and retinal diagnostic throughput, which could make this provider an important local referral destination for retinal disease management.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
21 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4,970 | $690 | $3.4M |
| J2778 | Injection, ranibizumab, 0.1 mg | 1,300 | $180 | $238.3K |
| 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. | 2,530 | $80 | $209.6K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 4,320 | $30 | $125.3K |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 660 | $180 | $115.5K |
| 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. | 3,360 | $20 | $80.6K |
| 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… | 1,240 | $50 | $61.8K |
| J3590 | Unclassified biologics | 30 | $2,050 | $59.4K |
| J3490 | Unclassified drugs | 30 | $1,770 | $53K |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 180 | $220 | $38.9K |
Showing 1–10 of 21
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 21 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
21 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J2778 | 5 | 10 | 1,300 | $180 | $1.3M |
| J0178 | 3 | 20 | 670 | $680 | $990.1K |
| J2777 | 9 | 10 | 8,460 | $30 | $325.2K |
| 67028 | 4 | 30 | 600 | $80 | $107K |
| Q5128 | 4 | 10 | 440 | $220 | $87.3K |
| J7999 | 6 | 10 | 150 | $150 | $64.6K |
| Q5124 | 1 | 10 | 320 | $170 | $62.5K |
| J3590 | 2 | 10 | 30 | $2,240 | $53.7K |
| 67041 | 7 | 10 | 20 | $1,090 | $35.9K |
| 67036 | 8 | 10 | 20 | $890 | $25.7K |
Showing 1–10 of 21
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. | 50 | $30 | $1.8K |
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
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. | 24 | 40 | 70 | $10 | $19.3K |
Other providers in the same ZIP code as Michael Borne, ranked by combined Medicare and Medicaid revenue.
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