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NPI 1588862320 · Eugene, OR · Ophthalmology Physician
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John Karth is a ophthalmology physician provider located in Eugene, Oregon. 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 | John Karth |
| Address | 1550 Oak St Ste 7 |
| City | Eugene |
| State | OR |
| ZIP | 97401 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | July 3, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.5M |
| Medicaid | $440 |
This provider’s Medicare revenue dwarfs its Medicaid billing: lifetime Medicare revenue is $4.5M while lifetime Medicaid revenue is $445, indicating Medicare is effectively the primary payer for this practice. The Medicaid totals reported are negligible relative to Medicare and are fully concentrated in retina-imaging services per the claims list.
Medicare revenue is highly concentrated in intravitreal drug codes: the top 3 Medicare codes (J2777, J0178, 67028) account for 87.5% of Medicare revenue, with J2777 at $2M (42.9%), J0178 at $1.8M (39.2%), and 67028 at $247.9K (5.4%). This concentration shows the business is driven by high-volume and high-cost retinal injection therapies rather than broad multispecialty office encounters.
Clinical/service-line mix is consistent with an office-based retinal injection practice supplemented by retinal diagnostics: the two leading Medicare revenue drivers are J2777 and J0178 (intravitreal injections) and imaging code 92134 also appears among top items (92134 Medicare revenue $105.4K, 2.3%), reflecting both therapeutic injections and retinal imaging follow-up. This pattern suggests routine, recurring anti-VEGF and related biologic administration with diagnostic imaging support.
Competitive standing is mixed by code: for J2777 the provider ranks #56 of 2039 (97th percentile) and is described as notably above typical national volume, indicating a strong national footprint for faricimab administration; by contrast J0178 ranks #281 of 3204 (91th percentile) with typical, unremarkable volume, so the provider is a major user of one specific biologic but a more typical user of the other. Additionally, Medicare 92134 ranks #197 of 26868 (99th percentile) and is labeled an extreme outlier, reinforcing unusually high retinal imaging activity relative to peers.
Medicaid activity is minimal and narrowly focused: Medicaid billing is reported as $445 in total but the Medicaid top code list shows 92134 with $448 and 100.0% of Medicaid revenue, indicating all Medicaid-reported encounters fall under retinal imaging (14 claims, $32 avg paid/claim). In-state competitive standing for that code is modest—rank #39 of 41 (5th percentile) and described as typical, unremarkable volume—so this provider is not a major Medicaid retinal imaging participant in Oregon.
Several codes stand out as statistical outliers or high-cost drivers on Medicare beyond the injections: 92134 is an extreme outlier (99th percentile) and 99213 is also an extreme outlier (99th percentile), while J3490 shows a high average paid/claim ($1759) producing $147.8K (3.2% of Medicare revenue) and is characterized as typical, unremarkable volume nationally. These labels point to unusually heavy utilization of specific imaging and E/M codes alongside concentrated high-dollar drug billing.
The provider’s coding mix shows operational concentration risk tied to biologic utilization and reimbursement: two biologic/drug codes (J2777 $2M and J0178 $1.8M) dominate Medicare revenue, so shifts in drug selection, price, or coverage policy could materially affect practice revenue. The practice appears optimized for recurring intravitreal therapy delivery and retinal imaging rather than a broad mix of ophthalmic surgical or primary eye-care services.
Provider tenure is long-standing: the NPI was enumerated 2007-07-03 (~19 years ago), which supports interpretation of these patterns as established practice behavior rather than a short-term billing spike. Long tenure combined with concentrated drug and imaging volumes suggests a stable, specialized ophthalmology operation focused on 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 |
|---|---|---|---|---|
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 67,320 | $30 | $2M |
| J0178 | Injection, aflibercept, 1 mg | 2,600 | $690 | $1.8M |
| 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. | 2,720 | $90 | $247.9K |
| J3490 | Unclassified drugs | 80 | $1,760 | $147.8K |
| 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. | 3,640 | $30 | $105.4K |
| 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… | 880 | $90 | $80.4K |
| 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… | 1,180 | $60 | $68.6K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 560 | $120 | $66.6K |
| J7999 | Compounded drug, not otherwise classified | 560 | $70 | $36.7K |
| 67108 | The provider repairs a detached retina using heat produced by a laser beam or by freezing the tissues. He may attach a scleral buckle to simplify the passage of fluid through and behind the retina or… | 10 | $870 | $11.3K |
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 |
|---|---|---|---|---|---|
| J0178 | 1 | 60 | 840 | $680 | $623.7K |
| J2777 | 3 | 30 | 10,050 | $30 | $527.6K |
| J2781 | 7 | 10 | 690 | $120 | $102.6K |
| 67028 | 2 | 70 | 580 | $90 | $72.3K |
| J3490 | 13 | 50 | 40 | $640 | $42.9K |
| 67036 | 10 | 10 | 30 | $1,000 | $29K |
| 67042 | 10 | 10 | 20 | $1,100 | $27.5K |
| 67108 | 10 | 10 | 20 | $1,030 | $25.7K |
| J7999 | 11 | 50 | 270 | $70 | $23.4K |
| 92235 | 12 | 30 | 60 | $100 | $11.1K |
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. | 10 | $30 | $450 |
How this provider's Medicaid billing volume and revenue compare to other Oregon providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Oregon 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. | 39 | 40 | 1,240 | $20 | $82.9K |
Other providers in the same ZIP code as John Karth, ranked by combined Medicare and Medicaid revenue.
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