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NPI 1588975346 · Brentwood, MO · Retina Specialist (Ophthalmology) Physician
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Athanasios Papakostas is a retina specialist (ophthalmology) physician provider located in Brentwood, Missouri. 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 | Athanasios Papakostas |
| Address | 1600 S Brentwood Blvd Ste 700 |
| City | Brentwood |
| State | MO |
| ZIP | 63144 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | June 27, 2010 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.3M |
| Medicaid | $103.5K |
Provider is effectively Medicare-centric by scale: reported Total Medicare revenue is $2.3M compared with Total Medicaid revenue of $103.5K, making Medicare the clear primary payer for this practice and Medicaid a much smaller revenue contributor. This concentration in Medicare suggests the practice’s patient mix and revenue sensitivity are largely tied to Medicare policy and reimbursement changes.
Revenue concentration on Medicare is highly focused in intravitreal biologic injections: the precomputed top-three Medicare codes (J2777, J0178, J2778) account for 79.5% of Medicare revenue, with J2777 generating $833.5K (36.9%), J0178 $537K (23.8%), and J2778 $426.1K (18.9%). These three codes are anti-VEGF or related intravitreal injections, indicating the practice operates as a high-volume medical-retina/injection service line.
Despite the heavy Medicare injection revenue, the provider’s national standing on those specific injection codes is not uniformly dominant: J2777 ranks #317 of 2039 (84th percentile; typical, unremarkable volume), J0178 ranks #1511 of 3204 (53th percentile; typical, unremarkable volume), and J2778 ranks #176 of 1208 (86th percentile; typical, unremarkable volume). In plain terms, the practice achieves substantial revenue from injections but generally reports volumes that are typical rather than consistently market-leading for these drugs at the national level.
Diagnostic imaging and established-visit volumes are a clear service-line strength nationally: 92134 is listed as an extreme outlier (2.7K claims, $79.3K revenue; 98th percentile; far above typical national volume) and 92014 is noted as notably above typical national volume (1K claims, $92.8K revenue; 96th percentile). This combination — high OCT/imaging throughput plus above-typical established visit volume — points to a busy clinic workflow that supports repeated monitoring and injection follow-up.
Medicaid revenue is tightly concentrated in outpatient eye exams and imaging: the precomputed top-three Medicaid codes (92014, 92134, 92250) account for 89.3% of Medicaid revenue, with 92014 at $34.2K (33.0%), 92134 at $31.1K (30.0%), and 92250 at $27.3K (26.3%). That mix indicates Medicaid activity is primarily diagnostic and evaluation-driven (comprehensive exams, OCT, and fundus photography) rather than surgical or high-cost drug billing.
Within the state Medicaid market the provider shows moderate-to-strong utilization but not statewide dominance: 92014 ranks #178 of 560 in-state (68th percentile; typical, unremarkable volume), 92134 ranks #17 of 62 (74th percentile; typical, unremarkable volume), and 92250 ranks #9 of 52 (84th percentile; typical, unremarkable volume). This pattern implies the provider is a meaningful regional supplier of retinal imaging and photography for Medicaid patients but not an outlier controlling statewide volume.
Surgical retina procedures and other operative codes are present but represent a small share of Medicare revenue: 67028 has 1.3K claims and $118.8K revenue (5.3%), while vitrectomy/repair codes such as 67042 ($17K) and 67113 ($14.1K) appear at much lower volumes. Operationally, this indicates the practice performs occasional retina surgeries but is primarily structured around injections, clinic visits, and diagnostic imaging rather than being a high-volume surgical retina center.
Provider tenure is long enough to signal an established practice: NPI enumerated 2010-06-27 (~16 years ago). Combined with the high revenue concentration in a small set of injection and imaging codes, the profile indicates both an established retinal specialty practice and a business model that carries concentration risk if reimbursement or utilization for those top codes shifts.
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 |
|---|---|---|---|---|
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 28,740 | $30 | $833.5K |
| J0178 | Injection, aflibercept, 1 mg | 790 | $680 | $537K |
| J2778 | Injection, ranibizumab, 0.1 mg | 2,340 | $180 | $426.1K |
| 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. | 1,290 | $90 | $118.8K |
| 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… | 1,020 | $90 | $92.8K |
| 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. | 2,740 | $30 | $79.3K |
| 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 | $46.1K |
| 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 | $120 | $22K |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 110 | $180 | $19.5K |
| 67042 | In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina… | 20 | $890 | $17K |
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.
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 |
|---|---|---|---|---|---|
| J0178 | 32 | 60 | 820 | $690 | $683.3K |
| J2777 | 5 | 50 | 11,730 | $30 | $388.9K |
| J2778 | 3 | 20 | 540 | $180 | $203.8K |
| Q5124 | 3 | 10 | 680 | $170 | $110.5K |
| 67028 | 16 | 80 | 600 | $90 | $69.7K |
| 67042 | 17 | 30 | 20 | $1,070 | $26.8K |
| 67113 | 7 | 10 | 20 | $1,170 | $25.8K |
| 67036 | 11 | 20 | 20 | $980 | $25.5K |
| J9035 | 36 | 40 | 170 | $60 | $21.8K |
| 92014 | 20 | 730 | 120 | $80 | $18K |
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 |
|---|---|---|---|---|
| 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… | 440 | $80 | $34.2K |
| 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. | 1,040 | $30 | $31.1K |
| 92250 | Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,… | 780 | $40 | $27.3K |
| 92226 | N/A | 220 | $20 | $5.3K |
| 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… | 20 | $150 | $3.2K |
| 92225 | N/A | 90 | $30 | $2.7K |
How this provider's Medicaid billing volume and revenue compare to other Missouri providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Missouri median
6 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 324 | 420 | 90 | $100 | $60.2K |
| 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… | 178 | 560 | 190 | $60 | $36K |
| 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. | 17 | 60 | 340 | $20 | $19.3K |
| 92225 | N/A | 5 | 10 | 90 | $50 | $8.3K |
| 92226 | N/A | 15 | 20 | 430 | $20 | $7.9K |
| 92250 | Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,… | 9 | 50 | 70 | $20 | $5.1K |
Other providers in the same ZIP code as Athanasios Papakostas, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Pyramid Homemaker Services, Inc. | MO | In Home Supportive Care Agency | $0 | $15.7M |
| Heeral Shah | MO | Retina Specialist (Ophthalmology) Physician | $1.6M | $0 |
| Sam Martin | MO | Interventional Pain Medicine Physician | $34.1K | $1.3M |
| Thomas Krummenacher | MO | Retina Specialist (Ophthalmology) Physician | $737.7K | $280 |
| Empowerme Diagnostics LLC | MO | Clinical Medical Laboratory | $271.9K | $0 |
| Rachel Darken | MO | Neurology Physician | $221.4K | $0 |
| Luqi Chi | MO | Neurology Physician | $137.3K | $0 |
| Craig Sorce | MO | Optometrist | $101.8K | $0 |
| Kelsey Melsheimer | MO | Occupational Therapist | $83.1K | $0 |
| Samir Cardona | MO | Physical Therapist | $79.7K | $0 |
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