Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Ohio for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Ohio only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Ohio (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Matthew Guess (NPI 1629230339)

Field	Value
Entity Type	Individual
Organization	Matthew Guess
Address	1945 Cei Dr
City	Blue Ash
State	OH
ZIP	45242
Taxonomy	Ophthalmology Physician
NPI Enumerated	June 25, 2008

Payer Source	Total Paid
Medicare	$2.8M
Medicaid	$0

Key Findings

MATTHEW GUESS is an Ophthalmology Physician in BLUE ASH, OH with $2.8M in lifetime Medicare revenue and no Medicaid billing on file, making his practice effectively single‑payer (Medicare) from the claims data provided. His NPI was enumerated 2008-06-25 (~18 years ago), indicating an established practice tenure that aligns with sustained Medicare activity.

Revenue is highly concentrated in intravitreal drug and injection services: the precomputed top‑three Medicare codes account for 78.4% of this provider’s Medicare revenue, led by J0178 at $1M (37.0%), J2777 at $955.6K (33.8%), and 67028 at $214.7K (7.6%). This concentration indicates that a few high‑cost drug administrations and the associated injection procedure drive the majority of billings.

The mix of top codes points to a retina‑focused clinical operation: J0178 (aflibercept) and J2777 (faricimab) are anti‑VEGF and related intravitreal biologic therapies, and 67028 is the isolated intravitreal injection procedure. Together this suggests the practice primarily delivers medical retina services (frequent injections and follow‑up retinal care) rather than being principally surgical or primary‑eye‑care focused.

Competitive standing on the highest‑revenue drugs is modest to above‑average but not dominant: J0178 ranks #805 of 3204 (75th percentile; typical, unremarkable volume) and J2777 ranks #252 of 2039 (88th percentile; typical, unremarkable volume), while 67028 ranks #521 of 4255 (88th percentile; typical, unremarkable volume). These ranks indicate the provider performs these services at volumes above many peers but remains one of many active national participants rather than a national outlier.

Two utilization measures are statistical outliers versus national peers: 92134 (retinal imaging) at 3.1K claims and $112.1K (4.0% of Medicare revenue) is labeled a 99th percentile extreme outlier, and 99213 (established office visits) at 1.2K claims and $95.4K (3.4%) is also a 99th percentile extreme outlier. These unusually high imaging and visit volumes, combined with high injection activity, reinforce a workflow optimized for frequent monitoring and follow‑up of retinal disease.

The practice bills a range of retina therapeutics beyond the top two agents, which shows clinical adoption of multiple treatment options: J7312 (dexamethasone implant) generated $72.5K (2.6%) and ranks #66 of 492 (87th percentile; typical), J9035 (bevacizumab) produced $37.3K (1.3%) and ranks #156 of 1852 (92th percentile; typical), and J2781 (pegcetacoplan) contributed $30.6K (1.1%) and ranks #448 of 490 (6th percentile; typical). This drug mix suggests the provider treats a range of retinal conditions and uses both established and newer agents, though some specific therapies have low national standing.

Surgical and diagnostic procedures beyond injections are present but represent modest revenue: cataract extraction 66984 generated $55.6K (2.0%) and vitrectomy codes 67041 and 67036 contributed $20.6K (0.7%) and $14.6K (0.5%) respectively, all described as typical, unremarkable volumes. This pattern indicates the practice performs occasional surgical cases but is primarily oriented toward outpatient retinal medical management.

From a payer‑mix and operational risk perspective, the absence of Medicaid billing removes one common source of lower‑reimbursement volume and suggests the patient panel is skewed toward Medicare beneficiaries; combined with the fact that 78.4% of Medicare revenue depends on three codes, the practice is sensitive to reimbursement or utilization shifts affecting intravitreal drugs and the injection procedure. Analysts should view the provider as a long‑tenured, retina‑centered Medicare provider with concentrated drug/procedure exposure and limited state‑payer diversification.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

26 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	1,520	$690	$1M
J2777	Injection, faricimab‑svoa, 0.1 mg	32,950	$30	$955.6K
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.	1,800	$120	$214.7K
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.	3,110	$40	$112.1K
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…	1,210	$80	$95.4K
J7312	Injection, dexamethasone, intravitreal implant, 0.1 mg	460	$160	$72.5K
66984	The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to…	120	$480	$55.6K
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…	340	$110	$39.1K
J9035	Injection, bevacizumab, 10 mg	680	$60	$37.3K
J2781	Injection, pegcetacoplan, intravitreal, 1 mg	260	$120	$30.6K

Showing 1–10 of 26

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 26 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. Ohio Distribution

Matthew Guess — 7 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. state median

26 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	28	100	840	$680	$729K
J2777	3	70	9,480	$30	$353.3K
J2781	16	20	1,040	$120	$152.4K
66984	338	530	210	$110	$92.8K
67028	11	150	470	$90	$64K
J7312	2	20	240	$160	$41.7K
67041	5	20	20	$1,180	$23.5K
67036	19	50	20	$870	$21K
66821	205	360	50	$180	$15.8K
92014	436	1,390	100	$70	$12.9K

Showing 1–10 of 26

Related Providers

Other providers that share a Tax Identification Number (TIN) with Matthew Guess, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Alaska Retinal Consultants	AK	Ophthalmology Physician	$0	$4.5M
Scott Limstrom	AK	Ophthalmology Physician	$3.2M	$0
Chad Bouchard	NY	Retina Specialist (Ophthalmology) Physician	$3.1M	$0
Philip Brunetti	AK	Ophthalmology Physician	$1.1M	$0
Steven Kirtland	WA	Pulmonary Disease Physician	$156.8K	$0
David Zumbro	AK	Ophthalmology Physician	$67.2K	$0
Catherine Peimann	AK	Internal Medicine Physician	$58.7K	$0
James Mckinney	AK	Family Medicine Physician	$46.3K	$0
Matthew Taintor	AK	Hospitalist Physician	$43.4K	$0
Benjamin Miller	AK	Surgery Physician	$42.6K	$0

Nearby Providers

Other providers in the same ZIP code as Matthew Guess, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Maxim Healthcare Services, Inc.	OH	Home Health Agency	$0	$63.6M
Bethesda Hospital Inc	OH	General Acute Care Hospital	$0	$57M
Hospice Of Cincinnati Incorporated	OH	Community Based Hospice Care Agency	$0	$54M
Carestar, Inc.	OH	Case Management Agency	$0	$43.1M
Counseling Source Inc	OH	Mental Health Counselor	$0	$41M
Mercy Health Physicians Cincinnati, LLC	OH	Family Medicine Physician	$0	$27.9M
Qualified Emergency Specialists Inc	OH	Emergency Medicine Physician	$0	$18.9M
Crossroads Hospice Of Cincinnati	OH	Community Based Hospice Care Agency	$0	$14.6M
A Best Home Care,inc.	OH	Home Health Agency	$0	$10.4M
Cei Physicians Psc LLC	OH	Ophthalmology Physician	$0	$8.5M

Matthew Guess — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References