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NPI 1750547733 · Wheaton, IL · Retina Specialist (Ophthalmology) Physician
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Vikram Setlur is a retina specialist (ophthalmology) physician provider located in Wheaton, Illinois. This profile covers 22 Medicare and 7 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 | Vikram Setlur |
| Address | 2015 N Main St |
| City | Wheaton |
| State | IL |
| ZIP | 60187 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | July 30, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.9M |
| Medicaid | $219.8K |
This provider is effectively Medicare‑dominant in scale: total Medicare revenue is $2.9M compared with total Medicaid revenue of $219.8K, indicating Medicare drives the vast majority of billed activity and revenue. The disparity suggests the practice’s core payer base and volume are anchored in the Medicare population rather than Medicaid enrollees.
Medicare revenue is highly concentrated: the top three Medicare codes by revenue account for 84.1% of the provider’s total Medicare revenue, led by J0178 (69.6% of Medicare revenue, $2M), followed by 67028 (7.3%, $209.3K) and 92014 (7.2%, $204.6K). This concentration indicates the practice’s Medicare line‑of‑business is overwhelmingly driven by intravitreal pharmacotherapy and related office evaluation services.
Medicaid revenue is similarly concentrated: the top three Medicaid codes by revenue account for 84.7% of the provider’s total Medicaid revenue, with 67028 producing 60.0% ($132.8K), 92134 at 12.9% ($28.5K), and J9035 at 11.8% ($26K). For Medicaid, the code mix shows injections and retinal imaging dominate billings, making the practice’s Medicaid book heavily weighted to procedural therapy rather than broad primary eye care.
The code mix and average paid/claim patterns point to a retina‑focused, high‑throughput injection clinic model: J0178 (aflibercept) is the single largest revenue driver on Medicare ($692 avg paid/claim, $2M revenue) and the presence of high claim counts for 92134 and 67028 indicates frequent retinal imaging and intravitreal injection procedures. Concurrently reported E/M codes (92014 and 99214) and numerous 92134 claims suggest ongoing monitoring and follow‑up visits are integral to operations rather than one‑off procedures.
National competitive standing on key Medicare codes is strong: J0178 ranks #200 of 3204 providers nationally (94th percentile) and is described as notably above typical national volume, while 92014 (rank #176 of 35415) and 92134 (rank #109 of 26868) are labeled extreme outliers (100th percentile) indicating this provider bills far above typical national volume for comprehensive established eye exams and retinal imaging. These rankings signal a substantial national‑scale presence for both therapeutic injections and diagnostic imaging.
In‑state Medicaid competitive standing is more modest: 67028 ranks #46 of 120 providers in‑state (62th percentile) and is characterized as typical, unremarkable volume; 92134 ranks #59 of 250 (77th percentile) and J9035 ranks #27 of 78 (66th percentile). These percentile positions suggest the provider is a capable, routine participant in the state Medicaid market for injections and imaging but not a dominant statewide leader.
Surgical retina activity exists but is a secondary component of the practice: codes such as 67042 ($39.2K revenue, 43 claims), 67108 ($27.7K, 30 claims) and 67036 ($23.9K, 34 claims) appear in the Medicare top 25 but represent small shares of total Medicare revenue compared with injectable therapies. The lower claim counts and single‑digit percentage shares for these surgical codes indicate the practice performs some operative cases but is primarily oriented toward non‑operative anti‑VEGF treatment and monitoring.
The provider is well established with an NPI enumerated on 2008-07-30 (~18 years ago), which combined with the high volumes on key retinal injection and imaging codes suggests an entrenched referral base and operational capacity for ongoing chronic care (regular injections and follow‑up imaging). This tenure supports the observed high throughput for Medicare injection and diagnostic services rather than a recently built or transient practice model.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
22 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,870 | $690 | $2M |
| 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. | 2,350 | $90 | $209.3K |
| 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… | 2,220 | $90 | $204.6K |
| 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. | 4,190 | $30 | $129.8K |
| 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… | 880 | $100 | $85.8K |
| J9035 | Injection, bevacizumab, 10 mg | 940 | $60 | $51.6K |
| 67042 | In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina… | 40 | $910 | $39.2K |
| 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… | 30 | $920 | $27.7K |
| 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… | 220 | $120 | $25.6K |
| 67036 | The provider removes vitreous fluid from the eye to access the posterior segment of the eye and introduce surgical instruments through incisions in the pars plana. | 30 | $700 | $23.9K |
Showing 1–10 of 22
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 22 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
22 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 6 | 140 | 700 | $690 | $688.4K |
| 67028 | 7 | 190 | 400 | $90 | $64.4K |
| 92014 | 12 | 1,420 | 130 | $80 | $24.7K |
| J9035 | 10 | 130 | 140 | $60 | $24.6K |
| 67210 | 18 | 20 | 30 | $410 | $22K |
| 67042 | 7 | 50 | 20 | $870 | $21.8K |
| 67108 | 3 | 30 | 20 | $880 | $17.6K |
| 67036 | 4 | 30 | 20 | $800 | $17.6K |
| 99214 | 463 | 18,540 | 110 | $80 | $17.1K |
| 67040 | 2 | 10 | 10 | $1,140 | $13.7K |
Showing 1–10 of 22
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.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 920 | $140 | $132.8K |
| 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. | 2,040 | $10 | $28.5K |
| J9035 | Injection, bevacizumab, 10 mg | 580 | $50 | $26K |
| 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… | 620 | $30 | $17.9K |
| 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… | 820 | $10 | $11.5K |
| 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… | 110 | $40 | $4.2K |
| 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… | 30 | $10 | $290 |
How this provider's Medicaid billing volume and revenue compare to other Illinois providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Illinois median
7 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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 | 120 | 540 | $160 | $166.3K |
| 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… | 536 | 1,230 | 450 | $40 | $54.1K |
| 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… | 9,978 | 14,680 | 300 | $50 | $48.7K |
| J9035 | Injection, bevacizumab, 10 mg | 27 | 80 | 290 | $60 | $43.4K |
| 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. | 59 | 250 | 510 | $20 | $20.1K |
| 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… | 132 | 670 | 230 | $30 | $16K |
| 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… | 39 | 50 | 110 | $10 | $5K |
Other providers in the same ZIP code as Vikram Setlur, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| County Of Dupage Department Of Health | IL | Mental Health Clinic/Center (Including Community Mental Health Center) | $0 | $13.7M |
| County Of Dupage Department Of Health | IL | Mental Health Clinic/Center (Including Community Mental Health Center) | $0 | $12.6M |
| City Of Wheaton | IL | Land Ambulance | $492.3K | $4.7M |
| Dupage Eye Surgery Center, LLC | IL | Ambulatory Surgical Clinic/Center | $4.5M | $0 |
| Gregory Fenton | IL | Ophthalmology Physician | $2.7M | $292.2K |
| Susan Anderson-nelson | IL | Retina Specialist (Ophthalmology) Physician | $1.5M | $14.5K |
| Mark Daily | IL | Ophthalmology Physician | $1.2M | $8.6K |
| Jon Gieser | IL | Retina Specialist (Ophthalmology) Physician | $771.4K | $0 |
| Steven Lafayette | IL | Ophthalmology Physician | $637K | $7.3K |
| Bradley Sacher | IL | Ophthalmology Physician | $527.6K | $16.1K |
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