Loading...
NPI 1811253289 · Appleton, WI · Retina Specialist (Ophthalmology) Physician
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Michael Possin is a retina specialist (ophthalmology) physician provider located in Appleton, Wisconsin. This profile covers 13 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 Possin |
| Address | 442 N Westhill Blvd Ste A |
| City | Appleton |
| State | WI |
| ZIP | 54914 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | April 10, 2012 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.7M |
| Medicaid | $360 |
This provider is a retina specialist whose billing is overwhelmingly driven by anti-VEGF intravitreal injections: J0178 (aflibercept) alone accounts for $1.2M and 71.4% of the provider's total Medicare revenue, and the precomputed top-3 Medicare codes together represent 91.8% of Medicare revenue. The code mix indicates a practice primarily focused on medical retinal injections rather than comprehensive ophthalmology or surgery.
Medicare dominates this provider's public-payer volume: lifetime Medicare revenue is $1.7M compared with Medicaid revenue of $356, so Medicaid is effectively de minimis in the payer mix. The provider should be treated as essentially single-payer (Medicare)-driven for revenue and utilization analyses.
Revenue concentration on a very small set of services is extreme on Medicare: the top 3 Medicare codes (led by J0178 at 71.4%) make up 91.8% of total Medicare revenue, signaling a highly specialized, procedure-centric practice model dependent on anti-VEGF therapy billing. This concentration implies that changes in drug utilization, reimbursement, or formularies for these agents would materially affect the provider's revenue.
Medicaid billing is minimal and concentrated: all Medicaid revenue ($356) is from 92134 (retinal imaging), with 12 claims reported and that code accounting for 100.0% of Medicaid revenue. The provider is not a meaningful Medicaid participant by dollars and offers limited Medicaid-facing services based on available claims.
Competitive standing on major Medicare codes is mixed. For J0178 the provider ranks #638 of 3204 nationally (80th percentile), which places them above average but not dominant — a solid, typical volume for aflibercept administration. For J2777 and 67028 the provider sits at more middle-to-high percentiles (39th and 81st respectively) indicating typical, unremarkable volumes relative to national peers for faricimab billing and vitreous injections.
There is one notable high-volume imaging signal: 92134 on Medicare shows 2K claims and $57.7K revenue and ranks #1042 of 26868 providers nationally (96th percentile), described as "notably above typical national volume." This suggests the provider generates substantial retinal imaging activity relative to most ophthalmologists, consistent with a retina-focused practice that pairs diagnostic imaging with injection therapy.
Tenure is long enough to support established practice patterns: the NPI was enumerated on 2012-04-10 (approximately 14 years ago), indicating over a decade of Medicare/Medicaid participation and giving context to the concentrated utilization profile as entrenched rather than transient.
Across both payers the provider shows a service-line profile concentrated on retina procedures and imaging rather than general ophthalmology E/M visits: E/M codes 99213/99204/99203 and comprehensive exam codes (92014/92004) together make up only a small share of Medicare revenue and volume, reinforcing a workflow centered on procedure-driven, procedural follow-up encounters rather than high-volume office evaluation visits.
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 | 1,790 | $680 | $1.2M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 7,320 | $30 | $212.3K |
| 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. | 1,510 | $90 | $137.2K |
| 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. | 1,990 | $30 | $57.7K |
| J9035 | Injection, bevacizumab, 10 mg | 750 | $50 | $38.9K |
| 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… | 410 | $60 | $25.1K |
| 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… | 80 | $110 | $8.7K |
| 99203 | The provider sees a new 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 provider… | 60 | $70 | $4.3K |
| 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… | 30 | $90 | $2.2K |
| 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… | 20 | $80 | $1.2K |
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 | 5 | 60 | 440 | $690 | $488.1K |
| J2777 | 12 | 30 | 7,290 | $30 | $332K |
| 67028 | 6 | 110 | 310 | $80 | $43.7K |
| J9035 | 6 | 70 | 110 | $50 | $14.5K |
| 92014 | 634 | 720 | 120 | $70 | $12.9K |
| 99214 | 9,207 | 9,800 | 80 | $70 | $9.2K |
| 92134 | 7 | 600 | 60 | $30 | $4.7K |
| 99213 | 194 | 9,380 | 60 | $50 | $4.7K |
| 92004 | 474 | 520 | 30 | $80 | $3.9K |
| 99204 | 274 | 3,390 | 30 | $100 | $3.7K |
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.
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. | 10 | $30 | $360 |
How this provider's Medicaid billing volume and revenue compare to other Wisconsin providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Wisconsin 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. | 50 | 50 | 410 | $10 | $20.9K |
Other providers in the same ZIP code as Michael Possin, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Options Lab, Inc. | WI | Clinical Medical Laboratory | $440.8K | $12.5M |
| Tri-county Community Dental Clinic, Inc. | WI | Dental Clinic/Center | $0 | $4.9M |
| Catalpa Health | WI | Community/Behavioral Health Agency | $0 | $4M |
| Appleton Dental Care LLC | WI | Dental Clinic/Center | $0 | $1.6M |
| Pinnacle Cataract And Laser Institute LLC | WI | Ambulatory Surgical Clinic/Center | $994.5K | $481.6K |
| Options Treatment Programs, Inc | WI | Mental Health Clinic/Center (Including Community Mental Health Center) | $0 | $1.2M |
| Micheal Vrabec | WI | Ophthalmology Physician | $380.3K | $0 |
| Douglas Salm | WI | Ophthalmology Physician | $314.9K | $0 |
| Ryan Funk | WI | Otolaryngology Physician | $217.6K | $34K |
| John Mcmahan | WI | Otolaryngology Physician | $99.7K | $0 |
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.