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NPI 1841451937 · New York, NY · Ophthalmology Physician
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Edward Marcus is a ophthalmology physician provider located in New York, New York. This profile covers 21 Medicare and 11 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 | Edward Marcus |
| Address | 140 E 80th St |
| City | New York |
| State | NY |
| ZIP | 10075 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | June 20, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.9M |
| Medicaid | $1.3M |
This clinician reports $3.9M in total Medicare revenue and $1.3M in total Medicaid revenue, so Medicare is the larger payer by scale and appears to be the primary revenue source for the practice. Both payers are active, but Medicare contributes the majority of the lifetime public-payer revenue on file for this NPI.
Revenue concentration is high on a small set of procedures for Medicare: the precomputed top 3 Medicare codes by revenue account for 57.7% of this provider's total Medicare revenue, led by J0178, J2777, and 67210. Those three codes combine high-cost intravitreal drug administration and retina laser, indicating a narrow set of high-revenue services drives most Medicare reimbursement.
Medicaid revenue is even more concentrated: the top 3 Medicaid codes by revenue account for 80.0% of this provider's total Medicaid revenue, with J0178 alone representing 45.1% of Medicaid revenue and 67210 and 67028 supplying the remaining major share. This pattern shows Medicaid billing is heavily weighted to aflibercept administration and retina procedures, making the provider particularly dependent on a small portfolio of retina-focused services for Medicaid patients.
The code mix and descriptions point to a retina-focused ophthalmology practice with a high volume of intravitreal injections (J0178, J2777, J2781, J0179), intravitreal implants (J7312, J7313), retinal laser (67210), and advanced retinal imaging (92134, 92235). The prominence of drug administration and retina procedures relative to evaluation codes suggests the operation is procedure-centric and oriented toward medical retina interventions rather than primarily office-based longitudinal care.
On Medicare, the provider is a national outlier for several retina procedures and imaging services: 67210 ranks #2 of 420 providers nationally (100th percentile; extreme outlier), 92134 ranks #166 of 26868 (99th percentile; extreme outlier), and J7312 ranks #5 of 492 (99th percentile; extreme outlier). At the same time, high-cost biologic administration J0178 ranks #591 of 3204 (82th percentile; typical, unremarkable volume), indicating that while the practice is unusually large for retina procedures and imaging, its national standing for some injection drugs is closer to typical peer volume.
Within New York Medicaid billing, the provider shows a strong in-state footprint for retina services: J0178 ranks #10 of 101 in-state (91th percentile; typical, unremarkable volume), 67210 ranks #4 of 26 (88th percentile; notably above typical state volume), 67028 ranks #17 of 262 (94th percentile; notably above typical state volume), and 92235 ranks #3 of 96 (98th percentile; notably above typical state volume). These state-level ranks reinforce that the clinician is a high-volume provider of retinal procedures and imaging in New York, particularly for procedures rather than general ophthalmology E&M.
Routine evaluation and management codes form a small share of revenue relative to procedures: on Medicare, 92012 and 92014 generate $66.8K (1.7%) and $58.1K (1.5%) respectively, and 99213 contributes $9.5K (0.2%); on Medicaid, 92012 generates $47.1K (3.6%) and 92014 $36.0K (2.8%). This distribution supports the conclusion that the practice is procedure- and imaging-dominant rather than visit-volume driven, with the bulk of reimbursement coming from injections, implants, laser, and diagnostic imaging.
The NPI has been enumerated since 2008-06-20 (~18 years ago), indicating an established clinical presence and likely sustained referral pathways for retina care. Combined with the concentrated high-volume procedural billing, tenure suggests a long-standing subspecialty practice rather than a recently transitioned or generalist operation.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
21 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 1,880 | $670 | $1.3M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 17,290 | $30 | $501.3K |
| 67210 | The provider destroys a lesion of the retina using a laser beam that heats up the tissue. | 1,050 | $470 | $488.3K |
| J3490 | Unclassified drugs | 240 | $1,500 | $357.5K |
| 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. | 2,010 | $110 | $215K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 1,470 | $110 | $163.2K |
| J7313 | Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg | 420 | $380 | $160.5K |
| J0179 | Injection, brolucizumab-dbll, 1 mg | 560 | $250 | $139.3K |
| 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. | 3,770 | $40 | $131.9K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 820 | $150 | $125.3K |
Showing 1–10 of 21
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 21 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
21 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 43 | 230 | 560 | $690 | $693K |
| J2777 | 25 | 120 | 7,740 | $30 | $364.9K |
| J7313 | 1 | 10 | 420 | $380 | $160.7K |
| J0179 | 1 | 10 | 270 | $250 | $88.2K |
| J2781 | 2 | 40 | 520 | $120 | $75.1K |
| Q5124 | 18 | 20 | 310 | $170 | $69.7K |
| 67028 | 20 | 300 | 400 | $100 | $65.9K |
| J3490 | 11 | 120 | 60 | $470 | $50.8K |
| J7312 | 1 | 20 | 270 | $160 | $48K |
| 67210 | 1 | 40 | 40 | $430 | $46.9K |
Showing 1–10 of 21
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.
11 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 1,400 | $420 | $588.1K |
| 67210 | The provider destroys a lesion of the retina using a laser beam that heats up the tissue. | 3,320 | $100 | $318.2K |
| 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. | 3,620 | $40 | $137.5K |
| 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… | 3,030 | $30 | $78.7K |
| 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. | 5,590 | $10 | $50.3K |
| 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… | 2,140 | $20 | $47.1K |
| 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… | 1,440 | $30 | $36K |
| 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,… | 1,920 | $10 | $26.9K |
| J9035 | Injection, bevacizumab, 10 mg | 950 | $20 | $20K |
| 92226 | N/A | 160 | $10 | $1.5K |
Showing 1–10 of 11
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
11 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 10 | 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… | 16,997 | 19,110 | 360 | $70 | $321K |
| 67210 | The provider destroys a lesion of the retina using a laser beam that heats up the tissue. | 4 | 30 | 100 | $250 | $211.4K |
| 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… | 598 | 2,440 | 330 | $70 | $92.6K |
| 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… | 226 | 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. | 17 | 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,… | 262 | 1,490 | 340 | $40 | $48.7K |
| J9035 | Injection, bevacizumab, 10 mg | 24 | 150 | 170 | $80 | $36.7K |
| 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… | 3 | 100 | 150 | $60 | $32.9K |
| 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. | 37 | 730 | 370 | $20 | $30K |
Showing 1–10 of 11
Other providers in the same ZIP code as Edward Marcus, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Lenox Hill Hospital | NY | General Acute Care Hospital | $0 | $63.2M |
| Retinal Ambulatory Surgery Center Of New York, Inc. | NY | Ambulatory Surgical Clinic/Center | $1.7M | $2.7M |
| Ben Cohen | NY | Retina Specialist (Ophthalmology) Physician | $2.5M | $942.8K |
| Leslie Miller | NY | Diagnostic Radiology Physician | $533.7K | $9.5K |
| Maurice Peters | NY | Diagnostic Radiology Physician | $301.8K | $13.9K |
| Matthew Hepinstall | NY | Orthopaedic Surgery Physician | $294.6K | $0 |
| Philip Rabito | NY | Specialist | $256.7K | $670 |
| Michael Cellini | NY | Diagnostic Radiology Physician | $237.8K | $0 |
| Paul-michel Dossous | NY | Diagnostic Radiology Physician | $195.4K | $25.9K |
| Ceri Hadda | NY | Geriatric Psychiatry Physician | $220.8K | $0 |
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