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NPI 1821035569 · West Plains, MO · Ophthalmology Physician
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Robert Jones is a ophthalmology physician provider located in West Plains, Missouri. This profile covers 23 Medicare and 18 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 | Robert Jones |
| Address | 1405 Doctors Dr |
| City | West Plains |
| State | MO |
| ZIP | 65775 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | June 1, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.6M |
| Medicaid | $239K |
Revenue concentration is high within each payer: the provider’s top 3 Medicare codes account for 77.4% of total Medicare revenue, and the top 3 Medicaid codes account for 72.7% of total Medicaid revenue. This indicates that a small set of procedures—primarily intravitreal pharmacologic injections and cataract surgery—drive the bulk of billed dollars to both payers.
Medicare dominates the payer mix by scale: lifetime Medicare revenue is $1.6M compared with $239K in Medicaid revenue, so the practice is effectively Medicare-dominant in absolute revenue. Medicaid is a meaningful secondary payer but contributes under one-fifth of the Medicare total, so operational and contracting priorities are likely driven by Medicare reimbursement patterns.
The practice’s Medicare portfolio is heavily weighted toward intravitreal biologic therapy, with J2777 (faricimab) representing 31.9K claims, $29 avg paid/claim, and $923.9K revenue (58.6% of this provider's total Medicare revenue). Coupled with J2778 (ranibizumab) and 67028 (intravitreal injection), the code mix points to a retina-focused service line that delivers high-volume injection therapy as a primary revenue driver.
Medicaid billing mirrors the injection-heavy profile: J2778 is the single largest Medicaid code at 265 claims, $271 avg paid/claim, $71.8K revenue (30.0% of this provider's total Medicaid revenue), and 67028 contributes 1.6K claims and $47.4K revenue (19.8% of Medicaid revenue). The Medicaid top-3 concentration (72.7%) reinforces that intravitreal injections plus cataract surgery are the core service lines across payers.
Competitive standing is mixed by code and payer: for Medicare, J2777 ranks #264 of 2039 providers nationally (87th percentile) and 66984 ranks #3186 of 15965 (80th percentile), indicating above-average national volume for faricimab and cataract procedures but not market dominance. For Medicaid, 66984 ranks #7 of 61 providers in-state (90th percentile) and 67028 ranks #7 of 34 (82nd percentile), which signals strong in-state cataract and injection activity relative to local peers.
There is a notable statistical outlier in evaluation-and-management billing: 99204 on Medicare produced 348 claims and $34.1K revenue (2.2% of Medicare revenue) and ranks #762 of 227068 providers nationally (100th percentile; extreme outlier). This unusually high ranking for moderate-complexity new-patient E/M visits may reflect practice-level intake patterns or billing concentrations in new-patient evaluation workflows.
Several diagnostic imaging codes show above-typical national volume on Medicare: 92136 (600 claims, $15K revenue) ranks in the 95th percentile and 92133 (389 claims, $9.3K revenue) also ranks in the 95th percentile, suggesting the practice routinely uses retinal and optic nerve imaging as part of its diagnostic pathway for retina and glaucoma-related care. High utilization of these imaging services supports a clinic workflow built around medical retina management and follow-up.
Provider tenure is long enough to indicate an established practice presence: the NPI was enumerated 2006-06-01 (~20 years ago). This duration, combined with concentrated high-volume injection codes and consistent cataract procedure billing across both payers, suggests a stable ophthalmology practice with an emphasis on intravitreal therapies and cataract surgery services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
23 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 31,860 | $30 | $923.9K |
| 66984 | The 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… | 440 | $360 | $154.9K |
| J2778 | Injection, ranibizumab, 0.1 mg | 810 | $170 | $141.3K |
| 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. | 740 | $90 | $62.8K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 290 | $160 | $46.2K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 210 | $190 | $40.2K |
| 65820 | The provider incises the limbus to improve drainage of aqueous humor in the eye. This procedure is typically performed on children, usually to treat congenital glaucoma. | 60 | $590 | $36.8K |
| 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. | 1,240 | $30 | $34.8K |
| 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… | 350 | $100 | $34.1K |
| 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… | 230 | $80 | $18.9K |
Showing 1–10 of 23
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 23 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
23 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J2777 | 3 | 50 | 11,730 | $30 | $388.9K |
| J2778 | 9 | 20 | 540 | $180 | $203.8K |
| 66984 | 43 | 420 | 50 | $390 | $74K |
| 67028 | 33 | 80 | 600 | $90 | $69.7K |
| 66991 | 6 | 30 | 30 | $1,230 | $55.5K |
| J7312 | 3 | 10 | 170 | $160 | $33.8K |
| 65820 | 6 | 40 | 30 | $790 | $29.1K |
| 66982 | 37 | 80 | 20 | $610 | $22.5K |
| 66821 | 30 | 220 | 50 | $210 | $21.2K |
| 92014 | 560 | 730 | 120 | $80 | $18K |
Showing 1–10 of 23
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.
18 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J2778 | Injection, ranibizumab, 0.1 mg | 270 | $270 | $71.8K |
| 66984 | The 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… | 440 | $130 | $54.9K |
| 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. | 1,640 | $30 | $47.4K |
| 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. | 2,560 | $10 | $20.5K |
| 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… | 870 | $20 | $15.7K |
| 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… | 670 | $20 | $14K |
| 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… | 120 | $40 | $5K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 110 | $30 | $3.5K |
| 92136 | The provider uses a noninvasive method to measure the patient’s eye or eyes to get information that the provider then uses to calculate the appropriate power for an intraocular lens (IOL). Selecting… | 220 | $10 | $1.8K |
| 92133 | The provider performs computerized diagnostic imaging of the optic nerve in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both… | 250 | $10 | $1.8K |
Showing 1–10 of 18
How this provider's Medicaid billing volume and revenue compare to other Missouri providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Missouri median
18 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 2,907 | 3,170 | 230 | $70 | $128.1K |
| 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… | 1,415 | 4,310 | 300 | $60 | $110.8K |
| 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. | 7 | 30 | 290 | $90 | $75.9K |
| J2778 | Injection, ranibizumab, 0.1 mg | 1 | 10 | 270 | $270 | $71.7K |
| 66984 | The 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… | 7 | 60 | 80 | $280 | $53.5K |
| 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… | 207 | 580 | 60 | $110 | $42K |
| 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… | 361 | 560 | 190 | $60 | $36K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 298 | 530 | 140 | $70 | $33.4K |
| 99212 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,… | 627 | 1,020 | 100 | $40 | $27K |
| 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… | 26 | 120 | 120 | $40 | $23.9K |
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Other providers in the same ZIP code as Robert Jones, ranked by combined Medicare and Medicaid revenue.
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