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NPI 1831286699 · Salt Lake City, UT · Retina Specialist (Ophthalmology) Physician
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Joel Herring is a retina specialist (ophthalmology) physician provider located in Salt Lake City, Utah. This profile covers 26 Medicare and 3 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 | Joel Herring |
| Address | 5169 S Cottonwood St Ste 630 |
| City | Salt Lake City |
| State | UT |
| ZIP | 84107 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | October 5, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $5.6M |
| Medicaid | $23.7K |
This provider is highly concentrated in anti-VEGF intravitreal therapy: J0178 (aflibercept) alone accounts for $4.7M in Medicare revenue and 83.8% of the provider's Medicare revenue, with 6.8K claims and an average paid/claim of $687. The dependence on a single drug code indicates the practice model is centered on high-volume, recurring intravitreal injections rather than broad procedural surgery or primary care visits.
Medicare revenue is overwhelmingly dominant compared with Medicaid for this provider: total Medicare revenue is $5.6M versus total Medicaid revenue of $23.7K, indicating the provider is effectively Medicare-focused at scale. The Medicaid contribution is de minimis relative to Medicare, so payer-mix exposure is concentrated in Medicare beneficiaries and fee schedules.
Revenue concentration in Medicare is extreme: the precomputed top 3 Medicare codes by revenue account for 91.1% of total Medicare revenue, meaning a very small set of services drives almost all Medicare receipts. For strategic review or risk assessment, monitoring utilization and reimbursement for these specific codes (especially J0178) is the highest priority.
National competitive standing is dominant for core retina services: J0178 ranks #7 of 3204 providers nationally (100th percentile; extreme outlier), indicating this provider is a national high-volume outlier for aflibercept injections. Additional Medicare codes tied to retina practice intensity — 67028 (3.4K claims, $296.6K revenue; ranks #61 of 4255, 99th percentile; extreme outlier) and 92134 (4.6K claims, $106.4K revenue; ranks #70 of 26868, 100th percentile; extreme outlier) — further support a market-leading procedural footprint within Medicare.
By contrast, Medicaid volumes and in-state ranks are modest: 67028 on Medicaid is 129 claims and $14.3K revenue (60.4% of Medicaid revenue) and ranks #10 of 12 in-state (18th percentile; typical, unremarkable volume), while 92134 is 293 claims and $9.4K revenue (39.6% of Medicaid revenue) and ranks #13 of 21 in-state (40th percentile; typical, unremarkable volume). These Medicaid rankings imply no comparable state-level dominance in the same services that drive Medicare revenue.
The practice mix includes substantial diagnostic imaging and office visits but at much smaller revenue shares: 92134 (retinal imaging) and E/M codes such as 99213 and 99203 together represent single-digit percentages of Medicare revenue (for example, 99213 contributes $91.9K or 1.6% of Medicare revenue). This pattern is consistent with a retina specialist model that pairs frequent injectable therapy with routine imaging and periodic E/M encounters for monitoring.
Surgical retina procedures are present but secondary: codes such as 67041 ($45.6K revenue, ranks #18 of 461, 96th percentile; notably above typical national volume) and 67113 ($16.9K revenue) appear in the billing mix, indicating the provider performs complex surgical retina work in addition to injection-based medical retina care. These procedures form a smaller fraction of overall revenue compared with injection therapy but demonstrate retained surgical capability.
The provider has long-term NPI tenure (NPI enumerated 2006-10-05, ~20 years), which aligns with an established specialty practice and helps explain the high procedural volumes, referral base, and sustained Medicare billing footprint observed in the data. Longevity together with national outlier ranks on core codes suggests an entrenched retina specialty operation rather than a recently scaled practice.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
26 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 6,830 | $690 | $4.7M |
| 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. | 3,370 | $90 | $296.6K |
| 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. | 4,630 | $20 | $106.4K |
| 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… | 1,610 | $60 | $91.9K |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 430 | $170 | $73.1K |
| J2778 | Injection, ranibizumab, 0.1 mg | 300 | $180 | $53.9K |
| J7999 | Compounded drug, not otherwise classified | 710 | $70 | $47.2K |
| 67041 | In this procedure, the provider removes scar tissue from the retinal membrane that obscures vision. He removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical… | 60 | $810 | $45.6K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 1,200 | $30 | $34.9K |
| J3590 | Unclassified biologics | 10 | $2,120 | $29.7K |
Showing 1–10 of 26
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 26 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
26 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 1 | 40 | 620 | $690 | $683.2K |
| J2777 | 13 | 20 | 13,140 | $30 | $523.9K |
| J2778 | 9 | 10 | 870 | $180 | $224.3K |
| 67028 | 3 | 60 | 440 | $90 | $61.7K |
| 67210 | 4 | 10 | 130 | $390 | $50.8K |
| Q5124 | 2 | 10 | 250 | $170 | $43.5K |
| 67041 | 2 | 10 | 20 | $1,040 | $28.2K |
| 67042 | 10 | 20 | 20 | $1,100 | $26.3K |
| 67036 | 12 | 20 | 20 | $1,010 | $24.2K |
| 67113 | 6 | 10 | 20 | $1,170 | $20K |
Showing 1–10 of 26
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.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 130 | $110 | $14.3K |
| 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. | 290 | $30 | $9.4K |
| J9035 | Injection, bevacizumab, 10 mg | 190 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Utah providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Utah median
3 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 10 | 10 | 1,350 | $100 | $124K |
| 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. | 13 | 20 | 430 | $30 | $36K |
| J9035 | Injection, bevacizumab, 10 mg | 2 | 10 | 150 | $20 | $4.2K |
Other providers in the same ZIP code as Joel Herring, ranked by combined Medicare and Medicaid revenue.
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