Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerNPI Medicare & MedicaidHeeral Shah
    Ask Trek AI about this page

    Heeral Shah — Billing Profile & Reimbursement Data

    NPI 1801907779 · Brentwood, MO · Retina Specialist (Ophthalmology) Physician

    Customize your policy alerts

    Sign up for Heeral Shah — Billing Profile & Reimbursement Data policy alerts

    Get alerted when relevant policies change without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Heeral Shah is a retina specialist (ophthalmology) physician provider located in Brentwood, Missouri. This profile covers 27 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

    Table of contents

    Progress1 / 9

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationHeeral Shah
    Address1600 S Brentwood Blvd Ste 700
    CityBrentwood
    StateMO
    ZIP63144
    TaxonomyRetina Specialist (Ophthalmology) Physician
    NPI EnumeratedAugust 31, 2006

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$1.6M
    Medicaid$0

    Key Findings

    This NPI corresponds to a retina specialist whose revenue profile is dominated by intravitreal drug administration and retina-specific diagnostics. The two largest revenue drivers are J2777 (faricimab) and J0178 (aflibercept), and the procedure mix also includes retinal imaging and injections such as 92134 and 67028, indicating an operation centered on high-volume anti-VEGF treatment and outpatient retinal care rather than broad multispecialty services.

    Revenue concentration is high: the precomputed top 3 Medicare codes by revenue account for 79.1% of this provider's total Medicare revenue. Those top three codes are J2777 ($656K, 40.4%), J0178 ($555.7K, 34.2%), and 66984 ($74.3K, 4.6%), making intravitreal biologics the primary financial engine for the practice.

    Payer mix is effectively single-payer Medicare: lifetime Medicare revenue is $1.6M and there is no Medicaid billing on file. The absence of Medicaid activity means the provider’s reimbursement exposure and contracting leverage are concentrated in Medicare and commercial arrangements rather than being balanced across public payers.

    Competitive standing across specific codes is mixed: J2777 posts 22.6K claims and ranks #451 of 2039 providers nationally (78th percentile; typical, unremarkable volume), while J0178 ranks #1490 of 3204 (54th percentile; typical, unremarkable volume). This pattern suggests solid participation in faricimab administration without clear dominance in aflibercept use relative to national peers.

    Clinic throughput appears strong for imaging and E/M work: 92012 generated 824 claims and $45.3K in revenue while ranking in the 96th percentile (notably above typical), and 92134 generated 1.5K claims and $40.6K while ranking in the 94th percentile (notably above typical). High percentile placement for these diagnostic and intermediate exam codes implies consistent outpatient volume and routine use of retinal imaging to support injection-based care.

    The provider shows a clear drug-selection pattern favoring faricimab and aflibercept as the primary biologics: J2777 and J0178 together drive the largest shares of Medicare revenue. By contrast, ranibizumab (J2778, $39.9K, ranks #1069 of 1208, 11th percentile) and bevacizumab (J9035, $2K, ranks #1576 of 1852, 14th percentile) are used at relatively low rates versus peers, indicating either clinical preference or formulary/administrative influences on agent choice.

    Tenure is long-standing: the NPI was enumerated 2006-08-31 (~20 years ago), which combined with $1.6M lifetime Medicare revenue suggests an established regional practice with sustained Medicare engagement. This longevity reinforces the pattern of a dedicated retina practice with persistent outpatient volume and biologic administration.

    Although injections and imaging dominate, the provider performs a modest volume of cataract and laser procedures that diversify practice activities beyond retina injections. Codes such as 66984 ($74.3K, 213 claims) and 66821 ($15.9K, 69 claims) appear as smaller but present revenue streams, indicating the practice also offers intraocular lens insertion and posterior capsulotomy services in addition to retina-focused care.

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

    The CPT/HCPCS codes generating the most Medicare revenue for this provider.

    27 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J2777Injection, faricimab‑svoa, 0.1 mg22,620$30$656K
    J0178Injection, aflibercept, 1 mg820$680$555.7K
    66984The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to…210$350$74.3K
    67028The 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.770$90$68.1K
    92012For 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$60$45.3K
    92134The 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.1,500$30$40.6K
    J2778Injection, ranibizumab, 0.1 mg230$180$39.9K
    J7312Injection, dexamethasone, intravitreal implant, 0.1 mg230$160$36.3K
    92014An 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…480$70$35.2K
    99204The 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…160$100$16.6K

    Showing 1–10 of 27

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 27 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    27 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J01783160820$690$683.3K
    J277765011,730$30$388.9K
    J27782220540$180$203.8K
    669849442050$390$74K
    670283180600$90$69.7K
    J7312510170$160$33.8K
    9224251070$190$27.9K
    66982518020$610$22.5K
    J90353040170$60$21.8K
    668219222050$210$21.2K

    Showing 1–10 of 27

    Related Providers

    Other providers that share a Tax Identification Number (TIN) with Heeral Shah, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Ramesh ShahMOSpecialist$857.8K$0

    Nearby Providers

    Other providers in the same ZIP code as Heeral Shah, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Pyramid Homemaker Services, Inc.MOIn Home Supportive Care Agency$0$15.7M
    Nicholas EngelbrechtMORetina Specialist (Ophthalmology) Physician$3.2M$10K
    Kevin BlinderMORetina Specialist (Ophthalmology) Physician$2.6M$39.4K
    Athanasios PapakostasMORetina Specialist (Ophthalmology) Physician$2.3M$103.5K
    Bradley SmithMORetina Specialist (Ophthalmology) Physician$2M$0
    Sabin DangMORetina Specialist (Ophthalmology) Physician$1.9M$1.5K
    Avinash HonasogeMORetina Specialist (Ophthalmology) Physician$1.7M$480
    Alia DurraniMORetina Specialist (Ophthalmology) Physician$1.5M$4.6K
    Sam MartinMOInterventional Pain Medicine Physician$34.1K$1.3M
    Barton BlackorbyMORetina Specialist (Ophthalmology) Physician$1.1M$0

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. Missouri Distribution
    Heeral Shah — 3 of 25 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Missouri