Loading...
NPI 1861806002 · Waterbury, CT · Ophthalmology Physician
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Neil Kalbag is a ophthalmology physician provider located in Waterbury, Connecticut. This profile covers 14 Medicare and 4 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 | Neil Kalbag |
| Address | 87 Grandview Ave |
| City | Waterbury |
| State | CT |
| ZIP | 06708 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | June 16, 2014 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.1M |
| Medicaid | $0 |
This provider's public billing footprint is effectively single‑payer: lifetime Medicare revenue is $1.1M while reported Medicaid revenue is $0, indicating no measurable Medicaid billing on file and strong reliance on Medicare as the sole public payer. That concentration in payer mix means payer-specific policies and Medicare reimbursement changes will disproportionately affect this practice's public revenue stream.
Revenue is highly concentrated in a very small set of services: the precomputed top 3 Medicare codes account for 88.3% of this provider's total Medicare revenue. The top three are J0178 ($661.4K, 58.8%), J2777 ($201.8K, 18.0%), and 92014 ($128.8K, 11.5%), showing that a few lines dominate the practice's Medicare receipts.
The code mix signals a retina-focused procedural practice supplemented by office-based ophthalmology: J0178 (aflibercept) and J2777 (faricimab) are the primary revenue drivers and together represent the majority of payments, while 67028 (intravitreal injection, $53.4K, 4.7%) further confirms a high volume of injection procedures. At the same time, 92014 ($128.8K, 11.5%) indicates substantial comprehensive follow-up work for established ophthalmology patients, suggesting ongoing medical management in addition to procedural care.
Competitive standing differs by service line: for office-based comprehensive exams (92014) the provider ranks #765 of 35415 nationally (98th percentile) and is described as notably above typical national volume, indicating they are a major national outlier for established-patient comprehensive ophthalmology visits. In contrast, for aflibercept injections (J0178) the provider ranks #1324 of 3204 (59th percentile; typical, unremarkable volume) and for faricimab (J2777) ranks #1286 of 2039 (37th percentile; typical, unremarkable), positioning the provider as a modest or average national participant in intravitreal drug administration by those benchmarks.
Several ancillary and diagnostic codes show meaningful use: 92134 (retinal imaging) generated $34.9K (3.1%) and is listed as typical, unremarkable volume at rank #1996 of 26868 (93th percentile), while extended ophthalmoscopy 92202 produced $12.3K (1.1%) and ranks #143 of 2327 (94th percentile; notably above typical national volume). These patterns suggest the practice maintains in-house diagnostic imaging and examination services to support retina care rather than outsourcing those functions.
Practitioner tenure supports an established local presence: the NPI was enumerated 2014-06-16 (~12 years ago), consistent with a sustained Medicare billing history that produced $1.1M in lifetime Medicare revenue. That duration combined with high 92014 volume implies stable referral or follow-up relationships with an older patient population.
The combination of high revenue concentration (88.3% from the top three codes) and zero Medicaid revenue highlights both operational vulnerability and potential strategic opportunity. Dependence on a small set of retina injection and exam codes leaves the provider exposed to changes in reimbursement, drug availability, or utilization patterns, while the absence of Medicaid billing suggests limited exposure to state program constraints but also missed opportunities to expand payer diversification locally.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
14 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 960 | $690 | $661.4K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 6,960 | $30 | $201.8K |
| 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… | 1,390 | $90 | $128.8K |
| 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. | 540 | $100 | $53.4K |
| 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. | 1,130 | $30 | $34.9K |
| 92202 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 1,030 | $10 | $12.3K |
| 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… | 90 | $90 | $8.7K |
| 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. | 80 | $110 | $8.1K |
| 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,… | 150 | $30 | $4.3K |
| 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… | 60 | $60 | $3.5K |
Showing 1–10 of 14
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 14 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
14 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 18 | 40 | 830 | $690 | $713.1K |
| J2777 | 18 | 30 | 8,190 | $30 | $340.4K |
| 67028 | 27 | 50 | 540 | $100 | $66.4K |
| 92014 | 4 | 580 | 100 | $90 | $18.6K |
| 99214 | 3,191 | 6,480 | 90 | $90 | $14.2K |
| 99213 | 3,736 | 6,440 | 70 | $60 | $8.1K |
| 92134 | 25 | 320 | 60 | $30 | $7.7K |
| 92004 | 66 | 410 | 30 | $110 | $5.2K |
| 92083 | 153 | 340 | 40 | $50 | $3.8K |
| 92250 | 70 | 430 | 60 | $30 | $3.1K |
Showing 1–10 of 14
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.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 60 | $0 | $0 |
| 92015 | The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced. | 20 | $0 | $0 |
| 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. | 30 | $0 | $0 |
| 92202 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 30 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Connecticut providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Connecticut median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 92015 | The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced. | 414 | 440 | 1,200 | $30 | $118.2K |
| 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… | 329 | 410 | 700 | $40 | $99.1K |
| 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. | 48 | 60 | 290 | $10 | $31.7K |
| 92202 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 19 | 30 | 70 | $1 | $3.7K |
Other providers in the same ZIP code as Neil Kalbag, ranked by combined Medicare and Medicaid revenue.
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.