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NPI 1821281395 · Plattsburgh, NY · Ophthalmology Physician
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Roy Arogyasami is a ophthalmology physician provider located in Plattsburgh, New York. This profile covers 15 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 | Roy Arogyasami |
| Address | 450 Margaret St |
| City | Plattsburgh |
| State | NY |
| ZIP | 12901 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | August 19, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.7M |
| Medicaid | $1.1M |
Provider is heavily Medicare-weighted by scale: reported lifetime Medicare revenue is $4.7M versus Medicaid revenue of $1.1M, indicating Medicare is the dominant payer for this practice's billed services and overall revenue stream. This scale difference suggests payer strategies or utilization will be driven primarily by Medicare patterns.
Extremely concentrated Medicare revenue mix: the precomputed top 3 Medicare codes by revenue account for 90.0% of this provider's total Medicare revenue, with J0178 alone generating $3.8M (82.3% of Medicare revenue). That concentration indicates the business is highly dependent on a very small set of services for its Medicare income.
Medicaid revenue is even more concentrated and focused on the same drug: the top 3 Medicaid codes by revenue account for 98.1% of Medicaid revenue, and J0178 represents $981.9K or 88.8% of the provider's Medicaid revenue. This creates a concentrated drug-spend exposure for Medicaid as well as Medicare tied to a single high-volume medication code.
Clinical/service-line profile points to a retina-focused intravitreal injection practice: high revenue and claim counts for J0178 (aflibercept) and large volumes of 67028 (intravitreal injection) and retinal imaging 92134 indicate routine, repeated intravitreal pharmacologic therapy supported by diagnostic retinal imaging and frequent injection encounters. The mix (dominant anti-VEGF injections plus retinal imaging) is consistent with a practice oriented to chronic retinal disease management rather than general comprehensive ophthalmology.
National competitive standing on key Medicare codes is prominent: J0178 ranks #18 of 3204 providers nationally (99th percentile; extreme outlier), and 92012 ranks #117 of 17177 providers nationally (99th percentile; extreme outlier), while 92134 ranks #648 of 26868 providers nationally (98th percentile; extreme outlier). These ranks indicate this provider is an unusually high-volume national outlier on aflibercept administration and some retina-related office visits/imaging.
State-level position on Medicaid shows notable dominance for the same drug: J0178 ranks #6 of 101 providers in-state (95th percentile; notably above typical state volume) and 67028 ranks #23 of 262 in-state (92nd percentile). Within New York Medicaid, the provider is a top-tier contributor of aflibercept administration and high on intravitreal injection volume relative to peers.
Mixed pattern of outlier versus typical volumes across other codes suggests a focused service model rather than broad-based practice: several retina imaging codes (e.g., 92134) and intermediate exam code 92012 are extreme outliers in volume, while alternative injectable agents (e.g., J2777 labeled typical/unremarkable volume) and several E/M codes are within typical ranges. This combination reinforces that most revenue and utilization come from a narrow set of high-frequency retinal procedures and drugs, not from general E/M breadth.
Provider tenure suggests an established practice backbone: NPI enumerated on 2007-08-19 (~19 years ago), which aligns with the observed sustained, high-volume billing pattern for intravitreal therapies and retinal imaging. For payers and network managers, this indicates a long-standing, specialized provider whose utilization patterns are stable and concentrated around retinal injection 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.
15 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 5,580 | $690 | $3.8M |
| 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. | 2,830 | $90 | $249K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 3,960 | $30 | $114.8K |
| 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… | 1,740 | $60 | $106.1K |
| J2778 | Injection, ranibizumab, 0.1 mg | 540 | $180 | $94.2K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 740 | $120 | $88.2K |
| 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. | 2,530 | $30 | $73.3K |
| 92235 | The provider uses a special dye, fluorescein that causes the blood vessels in the one or both eyes to stand out in photographic images taken with the use of multiframe timing, or serial images, taken… | 250 | $100 | $24.3K |
| 67210 | The provider destroys a lesion of the retina using a laser beam that heats up the tissue. | 60 | $370 | $22.4K |
| 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… | 260 | $80 | $21.4K |
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 | 2 | 230 | 560 | $690 | $693K |
| J2777 | 93 | 120 | 7,740 | $30 | $364.9K |
| J2778 | 33 | 70 | 510 | $180 | $131.6K |
| J2781 | 12 | 40 | 520 | $120 | $75.1K |
| 67028 | 5 | 300 | 400 | $100 | $65.9K |
| 67210 | 17 | 40 | 40 | $430 | $46.9K |
| 92014 | 817 | 2,220 | 160 | $100 | $29.3K |
| 92012 | 21 | 1,640 | 100 | $70 | $17.4K |
| 92235 | 22 | 190 | 60 | $120 | $14.1K |
| 67228 | 46 | 50 | 30 | $300 | $11.5K |
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.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 2,160 | $460 | $981.9K |
| 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. | 2,740 | $30 | $85K |
| 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… | 1,590 | $10 | $17.4K |
| 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. | 2,130 | $10 | $10.7K |
| 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… | 210 | $30 | $5.3K |
| 92250 | Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,… | 300 | $10 | $3.6K |
| 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… | 110 | $20 | $1.7K |
How this provider's Medicaid billing volume and revenue compare to other New York providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New York median
7 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 6 | 100 | 280 | $650 | $369.9K |
| 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… | 12,763 | 19,110 | 360 | $70 | $321K |
| 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… | 8,502 | 16,550 | 220 | $90 | $186.8K |
| 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… | 294 | 1,460 | 310 | $60 | $88.1K |
| 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. | 23 | 260 | 420 | $70 | $65.6K |
| 92250 | Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,… | 781 | 1,490 | 340 | $40 | $48.7K |
| 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. | 136 | 730 | 370 | $20 | $30K |
Other providers in the same ZIP code as Roy Arogyasami, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Champlain Valley Physicians Hospital Medical Center | NY | General Acute Care Hospital | $0 | $35.9M |
| Champlain Valley Brace And Limb, L.L.C. | NY | Durable Medical Equipment & Medical Supplies | $0 | $21M |
| Surgical Pain Center Of The Adirondacks, LLC | NY | Ambulatory Surgical Clinic/Center | $930K | $225.6K |
| Plattsburgh Asc LLC | NY | Ambulatory Surgical Clinic/Center | $623.9K | $21.1K |
| Craig Hurwitz | NY | Nephrology Physician | $445K | $178.5K |
| Champlain Toxicology Lab, LLC | NY | Clinical Medical Laboratory | $228.2K | $269K |
| Afterhours Imaging, LLC | NY | Diagnostic Radiology Physician | $371.4K | $16.4K |
| Walgreen Co | NY | Pharmacy | $330.9K | $0 |
| Richard Webber | NY | Internal Medicine Physician | $278.6K | $10.6K |
| Anthony Vaccaro | NY | Radiation Oncology Physician | $268.9K | $0 |
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