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NPI 1689644973 · Mount Kisco, NY · Specialist
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Craig Fern is a specialist provider located in Mount Kisco, New York. This profile covers 13 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 | Craig Fern |
| Address | 105 S Bedford Rd |
| City | Mount Kisco |
| State | NY |
| ZIP | 10549 |
| Taxonomy | Specialist |
| NPI Enumerated | January 26, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.1M |
| Medicaid | $276.3K |
Clinical focus and service mix: Billing patterns show a high-volume ophthalmology/retina practice concentrated on intravitreal injections and posterior-segment imaging and follow-up care. Medicare claims are dominated by drug administration code J0178 (4.4K claims, $3.1M revenue) alongside procedure codes 67028 and imaging/office codes 92012 and 92134, which together point to an outpatient injection clinic model delivering anti-VEGF and related therapies with on-site diagnostic imaging and frequent follow-up visits. The concurrent presence of multiple injectable drug codes (J0178, J2777, J9035) across payers indicates routine use of several intravitreal agents.
Medicare revenue concentration: The provider’s Medicare revenue is highly concentrated, with the top three Medicare codes accounting for 89.7% of total Medicare revenue. J0178 alone represents 73.8% of Medicare revenue, while 92012 and 67028 represent 8.6% and 7.3% respectively, highlighting dependence on drug administration and related ophthalmic services for the bulk of Medicare receipts.
Medicaid revenue concentration: Medicaid billing is similarly concentrated: the top three Medicaid codes account for 85.5% of this provider’s total Medicaid revenue. The Medicaid mix is led by office/outpatient visits 92012 (41.3%), intravitreal injection 67028 (24.3%), and retinal imaging 92134 (20.0%), indicating the same core service lines drive revenue on the state program.
Payer mix and scale: This is a Medicare-dominant practice in dollar terms—lifetime Medicare revenue of $4.1M far exceeds lifetime Medicaid revenue of $276.3K, indicating the provider’s commercial/Medicare-facing business is the primary revenue engine and Medicaid is a much smaller share of overall volume. The disparity suggests payer strategy and capacity are oriented toward older or Medicare-eligible patients.
National competitive standing on Medicare: For key Medicare codes the provider ranks at or near the top nationally, with J0178 ranked #42 of 3204 (99th percentile; extreme outlier) and 92012 ranked #2 of 17177 (100th percentile; extreme outlier). These rank positions classify the provider as a national high-volume outlier for anti-VEGF administration and follow-up ophthalmic exams, rather than a typical regional or modest-volume clinic.
State-level competitive standing on Medicaid: By contrast, Medicaid ranks place the provider as an active but not dominant in-state participant: 92012 ranks #195 of 1458 (87th percentile), 67028 ranks #63 of 262 (76th percentile), and 92134 ranks #104 of 728 (86th percentile), all described as typical or unremarkable volumes relative to in-state peers. This suggests strong Medicare market share for injection services but only above-average, not leading, market position in the Medicaid population.
Operational implications from drug mix and throughput: High claim counts for intravitreal drug administration (Medicare J0178 4.4K claims; Medicare 67028 2.9K claims; Medicare J2777 5.5K claims alongside Medicaid J9035 720 claims) imply substantial injection throughput and recurring patient visits. The combination of high-volume drug administration and high-volume follow-up imaging/office visits (92134 and 92012) implies an operational model optimized for frequent, repeat procedures and diagnostics rather than episodic surgical interventions.
Tenure and practice stability: The provider’s NPI was enumerated on 2006-01-26 (~20 years ago), indicating long-tenure in practice. Coupled with the persistent, high-volume billing for injection and follow-up exam codes, this tenure supports an interpretation of an established retinal/ophthalmology practice with sustained referral and treatment patterns in Mount Kisco, NY.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
13 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 4,410 | $690 | $3.1M |
| 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… | 4,510 | $80 | $356K |
| 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. | 2,890 | $110 | $303.2K |
| 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. | 4,690 | $40 | $168.9K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 5,460 | $30 | $158.3K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 280 | $130 | $36.2K |
| J9035 | Injection, bevacizumab, 10 mg | 420 | $60 | $23.5K |
| 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… | 1,790 | $10 | $23.3K |
| 92201 | 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… | 240 | $20 | $5K |
| 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,… | 130 | $30 | $4.5K |
Showing 1–10 of 13
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
13 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 4 | 230 | 560 | $690 | $693K |
| J2777 | 77 | 120 | 7,740 | $30 | $364.9K |
| 67028 | 4 | 300 | 400 | $100 | $65.9K |
| 92012 | 1 | 1,640 | 100 | $70 | $17.4K |
| 92235 | 135 | 190 | 60 | $120 | $14.1K |
| 92134 | 4 | 1,580 | 90 | $30 | $11.2K |
| J9035 | 23 | 190 | 120 | $50 | $10K |
| 92004 | 62 | 1,750 | 50 | $110 | $9.2K |
| 76512 | 124 | 340 | 50 | $50 | $6.6K |
| 92250 | 610 | 1,700 | 80 | $30 | $5.2K |
Showing 1–10 of 13
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 |
|---|---|---|---|---|
| 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… | 2,600 | $40 | $114.6K |
| 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. | 1,270 | $50 | $67.3K |
| 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. | 2,770 | $20 | $55.4K |
| J9035 | Injection, bevacizumab, 10 mg | 720 | $30 | $21.6K |
| 92226 | N/A | 760 | $10 | $10.6K |
| 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… | 890 | $10 | $8K |
How this provider's Medicaid billing volume and revenue compare to other New York providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New York median
6 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 195 | 1,460 | 310 | $60 | $88.1K |
| 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. | 63 | 260 | 420 | $70 | $65.6K |
| J9035 | Injection, bevacizumab, 10 mg | 35 | 150 | 170 | $80 | $36.7K |
| 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. | 104 | 730 | 370 | $20 | $30K |
| 92226 | N/A | 99 | 400 | 270 | $20 | $12.6K |
| 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… | 138 | 530 | 210 | $10 | $9.8K |
Other providers in the same ZIP code as Craig Fern, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Optum Medical Care, P.C. | NY | Cardiovascular Disease Physician | $0 | $105.1M |
| Hcs Home Care Of Westchester Inc | NY | Home Health Agency | $0 | $40.5M |
| Starnet Emergency Services | NY | Land Ambulance | $2.8M | $2.9M |
| Eric Fitz | NY | Ophthalmology Physician | $2.2M | $1.3K |
| Daniel Mark | NY | Radiation Oncology Physician | $2.2M | $0 |
| Raisa Katz | NY | Vascular & Interventional Radiology Physician | $1M | $345.9K |
| Mt Kisco Surgery Center LLC | NY | Ambulatory Surgical Clinic/Center | $702.8K | $22.4K |
| Henry Janssen | NY | Diagnostic Radiology Physician | $672.5K | $0 |
| Melanie Warycha | NY | MOHS-Micrographic Surgery Physician | $643.2K | $0 |
| Daniel Brodoff | NY | Diagnostic Radiology Physician | $474.2K | $0 |
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