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NPI 1609162155 · Cumming, GA · Ophthalmology Physician
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Gregory Lee is a ophthalmology physician provider located in Cumming, Georgia. This profile covers 17 Medicare and 3 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 | Gregory Lee |
| Address | 990 Sanders Rd Ste 100 |
| City | Cumming |
| State | GA |
| ZIP | 30041 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | June 23, 2011 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.9M |
| Medicaid | $6.3K |
This provider’s book of business is overwhelmingly Medicare-driven: total Medicare revenue is $2.9M compared with total Medicaid revenue of $6.3K, so Medicare is the effective primary payer for this NPI. The provider has been enumerated since 2011-06-23 (~15 years ago), indicating a long tenure on file that aligns with an established Medicare billing history.
Medicare revenue is highly concentrated in injectable therapeutics: the precomputed top three Medicare codes account for 84.7% of total Medicare revenue, driven by J2777, J0178, and J2778. The code mix (faricimab J2777, aflibercept J0178, ranibizumab J2778) indicates an operation focused on intravitreal pharmacologic treatment for retinal disease rather than surgical or broad general ophthalmology.
J2777 shows large absolute volume with 39.5K claims and $1.1M revenue (39.8% of Medicare revenue) and ranks #169 of 2039 nationally (92th percentile), a level characterized in the file as typical/unremarkable for this code despite being a top revenue driver for this practice. J0178 likewise contributes $1.1M (36.7% of Medicare revenue) across 1.5K claims and ranks #793 of 3204 nationally (75th percentile), signaling robust but not dominant national standing for aflibercept administration.
J2778 contributes $236.4K (8.2% of Medicare revenue) across 1.3K claims and ranks #338 of 1208 nationally (72th percentile), consistent with a retina-focused service line that uses multiple anti-VEGF agents. Together these three therapeutic injection codes define the provider’s Medicare revenue base and suggest the practice’s clinical volume is concentrated in office-based intravitreal injections.
Beyond injections, diagnostic and evaluation codes show notable departures from typical volume: 92134 (retinal imaging) appears as an extreme outlier, with 2.7K claims and $82.4K revenue (2.9% of Medicare revenue) and a national rank of #521 of 26868 (98th percentile), indicating unusually high imaging throughput relative to peers. 92014 (comprehensive established exam) also bills at volumes notably above typical national volume (1K claims, $91.7K revenue, 3.2% of Medicare revenue; rank #1522 of 35415, 96th percentile), suggesting a steady mix of follow-up clinical visits alongside injection work.
The provider’s billing pattern includes unusually high new-patient higher-level E/M relative to national peers: 99204 is flagged as an extreme outlier (255 claims, $30.3K revenue, 1.1% of Medicare revenue; rank #2264 of 227068, 99th percentile). This may reflect episodic use of extended new-patient encounters or coding patterns worth monitoring for network planning, but it sits alongside the dominant injection-driven revenue profile.
Medicaid activity is minimal in scale and structurally different from Medicare: total Medicaid revenue is $6.3K and the precomputed top three Medicaid codes account for 100.0% of Medicaid revenue, split across 92014 (55 claims, $2.2K, 35.5%), 67028 (14 claims, $2K, 32.6%), and 92134 (152 claims, $2K, 31.9%). In-state ranks for these Medicaid codes are modest to low (for example 92014 ranks #48 of 66, 28th percentile), indicating the provider is not a major Medicaid retinal services contributor within the state.
Competitive standing is mixed by payer: on Medicare the provider is a high-volume, specialty retinal injector by revenue share but is generally a modest national participant for specific injection codes (percentiles in the range characterized as typical/unremarkable for J2777, J0178, J2778). On Medicaid the provider is effectively a minor player given the $6.3K total and middle-to-low in-state ranks for top codes, so Medicaid should be treated as a peripheral payer when assessing this provider for network or utilization projections.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
17 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 39,480 | $30 | $1.1M |
| J0178 | Injection, aflibercept, 1 mg | 1,540 | $690 | $1.1M |
| J2778 | Injection, ranibizumab, 0.1 mg | 1,310 | $180 | $236.4K |
| 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. | 1,660 | $90 | $154.8K |
| 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… | 1,040 | $90 | $91.7K |
| 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. | 2,750 | $30 | $82.4K |
| 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… | 260 | $120 | $30.3K |
| J3490 | Unclassified drugs | 20 | $1,760 | $30K |
| 92012 | For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any… | 260 | $70 | $17.6K |
| 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… | 10 | $790 | $9.4K |
Showing 1–10 of 17
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 17 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
17 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 14 | 70 | 970 | $680 | $700.6K |
| J2777 | 3 | 40 | 14,100 | $30 | $524.3K |
| J2778 | 13 | 30 | 1,170 | $180 | $286.2K |
| 67028 | 13 | 80 | 720 | $90 | $71.9K |
| 67041 | 6 | 10 | 10 | $1,140 | $30.7K |
| 67036 | 6 | 10 | 20 | $1,120 | $23.6K |
| J3490 | 49 | 50 | 50 | $320 | $19.8K |
| 92014 | 28 | 850 | 130 | $80 | $19.7K |
| 92012 | 85 | 380 | 90 | $60 | $10.5K |
| J9035 | 32 | 70 | 120 | $50 | $10.3K |
Showing 1–10 of 17
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.
3 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… | 60 | $40 | $2.2K |
| 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. | 10 | $140 | $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. | 150 | $10 | $2K |
How this provider's Medicaid billing volume and revenue compare to other Georgia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Georgia median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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… | 48 | 70 | 240 | $40 | $68.1K |
| 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. | 5 | 10 | 60 | $80 | $21.7K |
| 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. | 8 | 10 | 170 | $10 | $9.7K |
Other providers in the same ZIP code as Gregory Lee, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Advanced Center For Joint Surgery, LLC | GA | Ambulatory Surgical Clinic/Center | $8.4M | $0 |
| Gregg Soifer | GA | Physical Medicine & Rehabilitation Physician | $814.4K | $0 |
| Charles Decook | GA | Orthopaedic Surgery Physician | $759.9K | $0 |
| Forsyth Eye Surgery Center, LLC | GA | Ambulatory Surgical Clinic/Center | $689K | $0 |
| Georgia Interventional Pain - C, LLC | GA | Ambulatory Surgical Clinic/Center | $659.4K | $0 |
| Angie Rink | GA | Professional Counselor | $0 | $541.3K |
| Bhaskar Reddy | GA | Cardiovascular Disease Physician | $521.6K | $0 |
| Julia Branch | GA | Family Nurse Practitioner | $488.4K | $0 |
| American Health Imaging Of Georgia, LLC | GA | Radiology Clinic/Center | $416.8K | $0 |
| Charles Nunez | GA | Optometrist | $310.8K | $105.3K |
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