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NPI 1699038935 · Plymouth Meeting, PA · Ophthalmology Physician
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Michael Cohen is a ophthalmology physician provider located in Plymouth Meeting, Pennsylvania. This profile covers 20 Medicare and 1 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 | Michael Cohen |
| Address | 4060 Butler Pike Ste 200 |
| City | Plymouth Meeting |
| State | PA |
| ZIP | 19462 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | June 21, 2012 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.9M |
| Medicaid | $1K |
Medicare is the overwhelmingly dominant payer for this provider: total Medicare revenue is $3.9M versus total Medicaid revenue of $1K, indicating an effectively single‑payer footprint with Medicare as the primary source of clinical activity and reimbursement. The provider’s Medicare billing scale dwarfs its Medicaid activity and should be treated as the core business line for network and utilization reviews.
Revenue concentration is high on a small set of therapies: the precomputed top 3 Medicare codes account for 78.2% of this provider’s Medicare revenue, showing dependence on a few procedure/drug lines for the majority of income. On Medicaid the top 3 codes account for 100.0% of Medicaid revenue, reflecting an extremely limited Medicaid case mix.
The top Medicare revenue drivers are intravitreal anti‑VEGF injections, consistent with a retina‑focused practice: J0178 accounts for $1.9M (49.3% of Medicare revenue) with 2.8K claims and $685 avg paid/claim, Q5128 accounts for $621.2K (15.9%) with 2.9K claims and $216 avg paid/claim, and J2778 accounts for $511.2K (13.1%) with 2.7K claims and $189 avg paid/claim. This mix—three high‑revenue injectable drug codes—indicates the clinic’s primary service line is office‑based intravitreal therapy for retinal disease rather than surgical retina or general ophthalmology.
Operational patterns support a high‑throughput injection clinic with in‑house diagnostics and follow‑up: 92012 (intermediate established eye exam) contributes $160.5K (4.1% of Medicare revenue) with 2.4K claims and is described as an extreme outlier, and 92134 (diagnostic retinal imaging) contributes $123K (3.1%) with 4.1K claims and is also an extreme outlier. High volumes of both exam and retinal imaging alongside the injection codes are consistent with bundled workflows (pre‑injection imaging, injection visit, and follow‑up visits) typical of retina specialty practices.
Competitive standing is mixed by code: for the single largest drug code J0178 the provider ranks #215 of 3204 providers nationally (93th percentile) and is noted as notably above typical national volume, indicating a strong national position for aflibercept injections. By contrast, Q5128 (rank #37 of 373, 90th percentile) and J2778 (rank #137 of 1208, 89th percentile) are characterized in the file as typical or unremarkable volumes despite relatively high rank positions, so while the provider is active on multiple ranibizumab products it appears most dominant on aflibercept.
The Medicaid footprint is minimal and narrowly concentrated: all Medicaid revenue ($975) is from 92134 (65 claims, $15 avg paid/claim) and represents 100.0% of the provider’s Medicaid revenue. In‑state competitive standing on 92134 is modest—rank #140 of 183 providers (24th percentile)—which suggests the provider is not a major Medicaid retina imaging vendor in Pennsylvania.
Provider tenure is established: the NPI was enumerated on 2012-06-21 (~14 years ago), indicating sustained billing activity over more than a decade. Combined with $3.9M lifetime Medicare revenue and concentrated, repeatable services (large injection volumes and diagnostic imaging), the profile suggests a stable, mature retina practice with concentrated clinical throughput rather than a broad multi‑service general ophthalmology operation.
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 |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,820 | $690 | $1.9M |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 2,880 | $220 | $621.2K |
| J2778 | Injection, ranibizumab, 0.1 mg | 2,710 | $190 | $511.2K |
| 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. | 2,400 | $90 | $225.8K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 6,060 | $30 | $175.7K |
| 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… | 2,400 | $70 | $160.5K |
| 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. | 4,100 | $30 | $123K |
| 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… | 730 | $90 | $65.9K |
| 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… | 320 | $130 | $39.9K |
| 67108 | The provider repairs a detached retina using heat produced by a laser beam or by freezing the tissues. He may attach a scleral buckle to simplify the passage of fluid through and behind the retina or… | 10 | $940 | $13.2K |
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 | 18 | 140 | 830 | $690 | $865.1K |
| Q5128 | 14 | 20 | 3,830 | $220 | $838.7K |
| J2778 | 20 | 70 | 1,030 | $190 | $417.1K |
| J2777 | 59 | 100 | 7,950 | $30 | $360.2K |
| 67028 | 19 | 180 | 600 | $90 | $87.5K |
| J7999 | 84 | 110 | 100 | $120 | $33.3K |
| 67042 | 39 | 50 | 20 | $1,100 | $31.9K |
| 92014 | 133 | 1,570 | 130 | $80 | $21K |
| 67108 | 16 | 20 | 20 | $910 | $20.1K |
| 67036 | 19 | 30 | 20 | $830 | $19.9K |
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.
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Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 70 | $20 | $980 |
How this provider's Medicaid billing volume and revenue compare to other Pennsylvania providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Pennsylvania median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 140 | 180 | 290 | $20 | $24.8K |
Other providers in the same ZIP code as Michael Cohen, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Gemma Services | PA | Psychiatric Residential Treatment Facility | $0 | $23.8M |
| Access Services Inc | PA | Community/Behavioral Health Agency | $0 | $8.3M |
| Arunan Sivalingam | PA | Ophthalmology Physician | $6M | $0 |
| Sunir Garg | PA | Ophthalmology Physician | $6M | $0 |
| Carl Park | PA | Ophthalmology Physician | $5.5M | $0 |
| Ajay Kuriyan | PA | Ophthalmology Physician | $5.3M | $6.6K |
| Plymouth Community Ambulance Assn | PA | Land Ambulance | $903.5K | $4.3M |
| Sonia Mehta | PA | Ophthalmology Physician | $4.9M | $0 |
| Jason Hsu | PA | Ophthalmology Physician | $4.4M | $0 |
| Religen | PA | Clinical Medical Laboratory | $349.2K | $1.7M |
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