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NPI 1881823581 · Durango, CO · Retina Specialist (Ophthalmology) Physician
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Kyle Piwonka is a retina specialist (ophthalmology) physician provider located in Durango, Colorado. This profile covers 26 Medicare and 2 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 | Kyle Piwonka |
| Address | 575 Rivergate Ln Unit 212 |
| City | Durango |
| State | CO |
| ZIP | 81301 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | July 2, 2009 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.7M |
| Medicaid | $0 |
Practice is heavily medical-retina and injection-focused: the revenue mix is dominated by intravitreal drug administrations and associated clinic procedures, with J0178 (aflibercept) alone accounting for $912.1K and 54.7% of Medicare revenue, and additional biologic agents and injection procedure billing (J2777, J2778, J9035 and 67028) appearing prominently in the top codes. High-volume diagnostic imaging (92134, 92250) and E/M visits (99214) support an office-based retina practice model rather than a predominantly surgical practice.
Acute revenue concentration around a few codes creates exposure: the precomputed top-3 Medicare codes (J0178, J2777, 67028) account for 72.2% of this provider’s total Medicare revenue, and J0178 alone is 54.7% of Medicare revenue. That concentration indicates the practice’s financial performance is highly dependent on anti-VEGF drug administration and the associated billing environment.
Medicare is effectively the sole payer represented: lifetime Medicare revenue is $1.7M while Medicaid revenue is $0, so the provider functions as a single-payer practice in the available data. This lack of Medicaid activity limits insight into state-level payer contracting and suggests payer risk or negotiation leverage will hinge on Medicare utilization and drug reimbursements.
Competitive standing on the lead drug is solid but not dominant: J0178 ranks #966 of 3204 providers nationally (70th percentile; typical, unremarkable volume) despite contributing $912.1K and 54.7% of this provider’s Medicare revenue. In plain terms, the provider bills substantial aflibercept volume relative to its own book of business, but nationally its J0178 workload is characteristic of many retina specialists rather than an outlier.
Imaging and office visit volumes are unusually high relative to peers: 92250 (fundus photography) is a pronounced outlier, ranking #490 of 25087 providers nationally (98th percentile; extreme outlier) while 99214 (established office visit) ranks #15236 of 479517 providers nationally (97th percentile; notably above typical). These elevated percentiles suggest a high diagnostic throughput and frequent follow-up or management visits consistent with chronic retinal disease management.
Surgical retina procedures are present but limited: operative codes such as 67108 ($16.1K, 1.0% of Medicare revenue) and 67113 ($15.7K, 0.9% of Medicare revenue) appear with low counts, and their national ranks (67108 #309 of 706, 52th percentile; 67113 #168 of 297, 36th percentile) indicate modest surgical volume. This pattern reinforces that the practice’s primary service line is office-based medical retina care rather than high-volume vitreoretinal surgery.
The provider offers a mix of anti-VEGF agents beyond aflibercept, which may reflect therapeutic flexibility or payer/formulary influences: J2777 (faricimab) appears with $165.3K and 9.9% of Medicare revenue, J2778 (ranibizumab) with $102.6K and 6.2%, and J9035 (bevacizumab) with $34.8K and 2.1%. The presence of multiple product codes across the top billings suggests treatment choices are not limited to a single drug, even though aflibercept is dominant in revenue.
Provider tenure is long enough to support an established referral base: the NPI was enumerated on 2009-07-02 (~17 years ago), signaling sustained enrollment and likely an established practice and patient panel that align with the high sustained volumes in injections, imaging, and E/M encounters.
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 | 1,320 | $690 | $912.1K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 5,700 | $30 | $165.3K |
| 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. | 1,330 | $90 | $125.2K |
| J2778 | Injection, ranibizumab, 0.1 mg | 600 | $170 | $102.6K |
| 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… | 890 | $100 | $89K |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 330 | $160 | $52.3K |
| 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. | 1,220 | $30 | $36.5K |
| J9035 | Injection, bevacizumab, 10 mg | 630 | $60 | $34.8K |
| 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,… | 770 | $30 | $22.3K |
| 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… | 160 | $130 | $20.1K |
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 | 16 | 60 | 740 | $690 | $618.3K |
| J2777 | 26 | 40 | 8,910 | $30 | $456.1K |
| J2778 | 11 | 20 | 600 | $180 | $199.7K |
| 67028 | 14 | 80 | 670 | $100 | $73.3K |
| J7312 | 2 | 10 | 220 | $160 | $37.4K |
| 67042 | 29 | 30 | 20 | $1,140 | $29.6K |
| 67108 | 10 | 20 | 20 | $1,260 | $26.5K |
| 67113 | 2 | 10 | 20 | $1,290 | $24.5K |
| 67041 | 5 | 10 | 10 | $1,260 | $21.4K |
| 66821 | 132 | 180 | 40 | $240 | $15.5K |
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.
2 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. | 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 |
How this provider's Medicaid billing volume and revenue compare to other Colorado providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Colorado median
2 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. | 36 | 40 | 410 | $80 | $167.8K |
| 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. | 61 | 70 | 360 | $20 | $47.2K |
Other providers in the same ZIP code as Kyle Piwonka, ranked by combined Medicare and Medicaid revenue.
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