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NPI 1639119167 · Ayer, MA · Ophthalmology Physician
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Gisela Velez is a ophthalmology physician provider located in Ayer, Massachusetts. This profile covers 21 Medicare and 9 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 | Gisela Velez |
| Address | 190 Groton Rd |
| City | Ayer |
| State | MA |
| ZIP | 01432 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | June 6, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.4M |
| Medicaid | $11.5K |
This provider is heavily Medicare‑weighted: lifetime Medicare revenue is $2.4M versus $11.5K in lifetime Medicaid revenue, indicating the practice operates at scale for Medicare beneficiaries and is effectively Medicare‑dominant in its payer mix. Medicaid activity is present but nominal in dollar terms compared with Medicare.
Revenue is concentrated in a few codes for both payers: the top three Medicare codes account for 64.8% of total Medicare revenue, and the top three Medicaid codes account for 58.0% of total Medicaid revenue. That concentration means a small group of services — primarily drug injections and related diagnostics — drive most of the reported revenue.
Clinical/service-line profile points to a retina/subspecialty practice centered on intravitreal therapies and advanced retinal diagnostics. J0178 (aflibercept) alone represents 41.6% of this provider’s Medicare revenue, and other high‑revenue Medicare entries (Q5124, J2778, 67028) are all anti‑VEGF or intravitreal injection codes; heavy use of OCT and angiography codes (92134, 92242, 92235) further supports a retina-focused service mix.
Operational footprint appears high for outpatient evaluation and imaging: 99214 is an extreme outlier nationally (ranks #540 of 479517 and is classified as an "extreme outlier"), and 92134 is likewise an extreme outlier (ranks #210 of 26868), indicating unusually large volumes of moderate-complexity established visits and retinal imaging compared with national peers. These patterns are consistent with a busy follow‑up and injection clinic model.
Competitive standing is mixed by code: J0178 (the largest Medicare revenue driver) ranks #847 of 3204 (74th percentile) and is described as a typical, unremarkable volume level nationally, while Q5124 ranks #14 of 122 (89th percentile) — a relatively prominent position among the smaller national cohort billing that biosimilar. At the same time, specialty diagnostics such as 92242 (ranks #10 of 206, 96th percentile) and 92273 (98th percentile) place the provider notably above typical national volume for these services.
Medicaid volumes and statewide rankings are modest and generally below dominant in‑state positions: 92250 ranks #97 of 172 in‑state (44th percentile) and 67028 ranks #46 of 59 (22th percentile), with other Medicaid codes similarly in the mid or lower percentiles. Combined with the $11.5K total Medicaid revenue, these signals indicate the provider is a modest participant in the Massachusetts Medicaid market relative to peers.
The practice shows substantial capability in specialized retinal diagnostics and procedures beyond injections: multiple codes tied to angiography and electrophysiology (92242, 92235, 92273) are classified as "notably above typical national volume" or better, implying investment in imaging/diagnostic capacity and regular use of advanced retinal testing modalities. This diagnostic intensity complements the high anti‑VEGF injection volume observed in Medicare billing.
Provider tenure is long-standing: NPI was enumerated on 2006-06-06 (~20 years ago), reflecting an established practice presence in AYER, MA that aligns with sustained procedural and visit volumes reported on Medicare over time.
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 | 1,460 | $690 | $1M |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 1,790 | $170 | $305.2K |
| 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… | 2,500 | $100 | $257.2K |
| 92242 | The provider injects two different special dyes into one or both eyes that cause the blood vessels to stand out in photographic images timed so that multiple frames are taken in rapid succession. He… | 630 | $240 | $149.5K |
| 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. | 1,370 | $100 | $134.6K |
| J2778 | Injection, ranibizumab, 0.1 mg | 740 | $180 | $133K |
| 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. | 3,570 | $30 | $121.4K |
| 92273 | The provider performs an electrophysiologic test of retinal function, which may be referred to as conventional, full–field or Ganzfeld (ffERG) or flash/focal (fERG) electroretinography to assess… | 650 | $110 | $70.5K |
| 92235 | The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken… | 530 | $120 | $65.7K |
| 92083 | The provider may use one or more methods to determine the extent of a patient's visual field of one or both eyes; he interprets the results and prepares a report. Report this code for an extended… | 1,160 | $50 | $60.4K |
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.
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Full comparison — all codes billed, vs. state median
21 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 22 | 90 | 790 | $690 | $826.5K |
| J2778 | 10 | 30 | 560 | $180 | $200.7K |
| Q5124 | 3 | 10 | 800 | $160 | $186K |
| 67028 | 28 | 120 | 570 | $100 | $80.7K |
| J7351 | 9 | 10 | 270 | $160 | $58.3K |
| 92242 | 1 | 10 | 80 | $240 | $47.6K |
| 92014 | 376 | 1,070 | 160 | $90 | $30.1K |
| 99214 | 4 | 15,410 | 110 | $80 | $15.6K |
| 92273 | 1 | 10 | 30 | $100 | $11K |
| 92134 | 10 | 670 | 70 | $30 | $10.6K |
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.
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Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
9 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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,… | 100 | $20 | $2.4K |
| 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. | 60 | $40 | $2.1K |
| 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… | 80 | $30 | $2.1K |
| 92235 | The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken… | 30 | $50 | $1.5K |
| 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. | 100 | $10 | $1.4K |
| 92226 | N/A | 100 | $10 | $720 |
| 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… | 20 | $40 | $660 |
| 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… | 10 | $30 | $340 |
| 92202 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 30 | $10 | $160 |
How this provider's Medicaid billing volume and revenue compare to other Massachusetts providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Massachusetts median
9 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 4,679 | 5,040 | 200 | $70 | $209.5K |
| 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. | 46 | 60 | 780 | $80 | $178.3K |
| 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… | 571 | 660 | 250 | $60 | $122.5K |
| 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… | 119 | 190 | 210 | $50 | $63.9K |
| 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. | 90 | 130 | 430 | $10 | $39.3K |
| 92235 | The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken… | 5 | 10 | 30 | $100 | $30.6K |
| 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,… | 97 | 170 | 180 | $20 | $21.9K |
| 92226 | N/A | 17 | 30 | 140 | $10 | $6.7K |
| 92202 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 14 | 20 | 160 | $10 | $3.9K |
Other providers in the same ZIP code as Gisela Velez, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Steward Emergency Physicians, Inc | MA | Emergency Medicine Physician | $0 | $58.7M |
| Nashoba Valley Medical Center, A Steward Family Hospital, Inc | MA | General Acute Care Hospital | $0 | $10.9M |
| Adam Cerel | MA | Cardiovascular Disease Physician | $567.7K | $299.4K |
| Jonathan Held | MA | Specialist | $154.6K | $0 |
| Asha Naidu | MA | Infectious Disease Physician | $121.2K | $0 |
| Paul Harasimowicz | MA | Specialist | $90.6K | $0 |
| Matthew Foley | MA | Diagnostic Radiology Physician | $88.4K | $0 |
| Michael Jonathan Older | MA | Gastroenterology Physician | $77.3K | $0 |
| Magdy Salama | MA | Anatomic Pathology Physician | $37.7K | $17.4K |
| Mary Bakalos | MA | Diagnostic Radiology Physician | $36.4K | $0 |
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