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NPI 1801274295 · Lexington, KY · Retina Specialist (Ophthalmology) Physician
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Aaron Ricca is a retina specialist (ophthalmology) physician provider located in Lexington, Kentucky. This profile covers 15 Medicare and 5 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 | Aaron Ricca |
| Address | 120 N Eagle Creek Dr Ste 500 |
| City | Lexington |
| State | KY |
| ZIP | 40509 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | May 18, 2015 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.5M |
| Medicaid | $307.6K |
Provider revenue is concentrated in Medicare with Total Medicare revenue of $2.5M versus Total Medicaid revenue of $307.6K, and the NPI was enumerated on 2015-05-18 (~11 years ago), indicating an established practice operating for about a decade. This payer mix shows Medicare is the dominant revenue source on file, while Medicaid represents a much smaller share of billed activity for this clinician.
Medicare revenue is heavily concentrated in intravitreal drug and injection procedure codes: the precomputed top three Medicare codes account for 89.3% of Medicare revenue, led by J0178 (72.0%), followed by J2777 (12.6%) and 67028 (4.7%). This concentration indicates the provider’s Medicare business is driven primarily by anti-VEGF biologic administration and isolated intravitreal injection procedures rather than broad office-based E/M billing or surgical volume.
Medicaid billing is even more concentrated: the precomputed top three Medicaid codes account for 96.8% of Medicaid revenue, with J0178 at 57.9%, 67028 at 28.8%, and 92134 at 10.1%. This pattern in Medicaid mirrors Medicare in emphasizing drug injections and intravitreal procedure throughput, with imaging (92134) as a secondary revenue component.
Aflibercept (J0178) is the single dominant revenue driver across both payers — it represents 72.0% of Medicare revenue and 57.9% of Medicaid revenue. For Medicare J0178 the provider ranks #285 of 3204 nationally (91th percentile; typical, unremarkable volume), while in-state Medicaid J0178 ranking is #6 of 9 (38th percentile; typical, unremarkable volume), suggesting strong reliance on this medication locally but only a moderately large position among in-state peers.
Clinical imaging and routine E/M show divergent intensity between payers: Medicare 92134 is ranked in the 95th percentile and labeled as "notably above typical national volume," indicating above-average use of retinal imaging for Medicare patients, and Medicare 99213 ranks in the 97th percentile (labeled "notably above typical national volume"), pointing to high follow-up visit throughput in the Medicare cohort. By contrast, the same E/M code on Medicaid (99213) ranks #2497 of 3339 in-state (25th percentile; typical, unremarkable volume), suggesting lower Medicaid outpatient E/M intensity relative to Medicare.
Surgical retina codes are present but contribute only a small share of Medicare revenue—67036 accounts for 0.6% and 67108 for 0.4% of Medicare revenue—indicating limited surgical case volume relative to injection and clinic-based services. The code mix therefore supports a practice model centered on injection clinic throughput with occasional surgical interventions rather than a high-volume surgical retina practice.
Adoption of newer intravitreal agents appears moderate: J2777 (faricimab) accounts for 12.6% of Medicare revenue and ranks #961 of 2039 nationally (53th percentile; typical, unremarkable volume), while J2778 (ranibizumab) represents 3.5% of Medicare revenue and ranks #778 of 1208 (36th percentile; typical, unremarkable volume). These ranks suggest the provider uses multiple anti-VEGF options but is not a dominant national prescriber of the newer agents.
Competitive standing is mixed by payer and code: for some high-revenue services the provider sits in upper national percentiles (for example Medicare 92134 at the 95th percentile and 99213 at the 97th percentile, both labeled "notably above typical national volume"), while for key drug codes the provider is described as having "typical, unremarkable" volume nationally for J0178 and modest in-state placement for J0178 on Medicaid (#6 of 9, 38th percentile). Overall, the profile fits an established retina specialist with a strong, injection-centric clinic presence in Medicare and a smaller, concentrated Medicaid practice footprint.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
15 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,600 | $690 | $1.8M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 10,800 | $30 | $313.2K |
| 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. | 1,410 | $80 | $116.9K |
| J2778 | Injection, ranibizumab, 0.1 mg | 470 | $180 | $86.1K |
| 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. | 1,710 | $30 | $44.5K |
| 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… | 680 | $60 | $40.2K |
| 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… | 310 | $90 | $28.1K |
| 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 | $640 | $16.1K |
| J3590 | Unclassified biologics | 100 | $120 | $12.1K |
| 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… | 110 | $110 | $11.3K |
Showing 1–10 of 15
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 15 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
15 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 8 | 40 | 870 | $690 | $858.5K |
| J2777 | 16 | 30 | 11,040 | $30 | $399.1K |
| J2778 | 13 | 20 | 700 | $180 | $148.3K |
| 67028 | 11 | 50 | 650 | $90 | $72.9K |
| 67036 | 9 | 20 | 20 | $910 | $28.1K |
| 67108 | 11 | 10 | 20 | $1,010 | $23.2K |
| J3590 | 26 | 40 | 160 | $60 | $17K |
| 99214 | 1,356 | 7,230 | 110 | $70 | $14.1K |
| 99213 | 182 | 7,250 | 80 | $50 | $7.7K |
| 67228 | 5 | 10 | 30 | $230 | $6.6K |
Showing 1–10 of 15
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.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 200 | $900 | $178.3K |
| 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. | 710 | $130 | $88.9K |
| 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. | 1,070 | $30 | $31.1K |
| 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… | 170 | $30 | $5.5K |
| J9035 | Injection, bevacizumab, 10 mg | 70 | $60 | $4.4K |
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 6 | 10 | 210 | $640 | $1.4M |
| 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… | 2,497 | 3,340 | 1,020 | $30 | $296K |
| 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. | 11 | 30 | 350 | $70 | $165.3K |
| J9035 | Injection, bevacizumab, 10 mg | 12 | 20 | 120 | $130 | $96.1K |
| 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. | 14 | 70 | 210 | $20 | $29.2K |
Other providers in the same ZIP code as Aaron Ricca, ranked by combined Medicare and Medicaid revenue.
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