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    OpenPayerNPI Medicare & MedicaidCharles Hejny
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    Charles Hejny — Billing Profile & Reimbursement Data

    NPI 1922013671 · Neenah, WI · Retina Specialist (Ophthalmology) Physician

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    Charles Hejny is a retina specialist (ophthalmology) physician provider located in Neenah, Wisconsin. This profile covers 16 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

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    Provider details (source: NPPES NPI Registry)

    FieldValue
    Entity TypeIndividual
    OrganizationCharles Hejny
    Address200 Theda Clark Plaza
    CityNeenah
    StateWI
    ZIP54956
    TaxonomyRetina Specialist (Ophthalmology) Physician
    NPI EnumeratedJuly 30, 2006

    Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)

    Payer SourceTotal Paid
    Medicare$834.4K
    Medicaid$0

    Key Findings

    This provider is effectively a single-payer Medicare practitioner: lifetime Medicare revenue totals $834.4K and there is no Medicaid billing on file, indicating negligible or no participation in state Medicaid programs and a payer mix dominated by Medicare. Analysts should treat this profile as Medicare-centric when assessing referral patterns, utilization, and revenue sustainability.

    Revenue is highly concentrated in intravitreal anti-VEGF therapy: J0178 (aflibercept) alone accounts for $600.1K and 71.9% of the provider's Medicare revenue, and the precomputed top 3 Medicare codes together account for 85.8% of Medicare revenue. This concentration indicates the practice’s primary service line is medical retina management of neovascular disease, with procedural and imaging codes supporting ongoing injection-based care.

    The code mix supports a retina-specialist practice model focused on high-volume drug administration and retinal imaging rather than broad general ophthalmology. High-volume J0178 injections plus substantial counts of 67028 (intravitreal injection procedure) and imaging codes like 92134 and 92235 suggest recurring office-based injection visits combined with retinal diagnostic testing to monitor response and guide treatment intervals.

    Competitive standing on key codes is mixed: for J0178 the provider ranks #1416 of 3204 (56th percentile), indicating typical, unremarkable national volume for aflibercept among peers rather than dominance. For bevacizumab J9035 the provider ranks at the 90th percentile (#192 of 1852), signaling notably higher-than-typical use of bevacizumab relative to peers despite that code representing a smaller share ($33.6K, 4.0% of Medicare revenue).

    Several diagnostic and office E/M codes show above-typical national volume, consistent with active longitudinal care: 92134 ranks in the 93rd percentile and 76512 ranks in the 80th percentile, both described as typical volumes but high in percentile rank, indicating the provider performs retinal imaging at rates well above many peers which aligns with frequent follow-up and monitoring of intravitreal therapy.

    Procedure-level diversity beyond injections is limited but present: retinal surgery codes such as 67028 and vitrectomy-related codes (67041, 67042) appear at much lower revenue shares (for example 67041 is $13.6K, 1.6% of Medicare revenue), indicating the provider performs some surgical interventions but that these are a small adjunct to the primary injection/monitoring service line. These surgery code percentiles are generally unremarkable to low, suggesting modest surgical volume.

    Tenure in the Medicare program is long-standing: the NPI was enumerated on 2006-07-30 (~20 years ago), which supports an established referral base and practice footprint in NEENAH, WI; longevity may underpin the consistent injection volumes and sustained Medicare revenue.

    Given the absence of Medicaid billing, competitive analysis and network contracting evaluations should focus on Medicare fee schedules and peer benchmarks for retina specialists; the provider’s national percentiles for key retina services place them as a competent, established regional retina specialist but not a national high-volume aflibercept outlier, so payers should expect stable, procedure-driven utilization rather than anomalous concentration across multiple payers.

    Medicare: Total Revenue Breakdown by CPT/HCPCS Code

    Medicare revenue breakdown by CPT/HCPCS procedure code.

    View: Bar Chart1 / 2

    Medicare: Complete Services Breakdown

    The CPT/HCPCS codes generating the most Medicare revenue for this provider.

    16 rows

    CPT/HCPCS CodeDescriptionClaimsAvg PaidRevenue
    J0178Injection, aflibercept, 1 mg880$690$600.1K
    67028The 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.880$90$82.5K
    J9035Injection, bevacizumab, 10 mg610$60$33.6K
    92134The 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.1,190$30$33.2K
    67041In 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…20$850$13.6K
    92012For 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…220$60$13.4K
    67228In retinopathy, tiny new vessels grow profusely and fibrous tissue proliferates in between the layers of the retina, which may extend into the optic nerve and vitreous, clear gel that fills the space…50$250$11.4K
    67042In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina…10$810$9.8K
    99204The 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…60$110$6.4K
    99213The 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…100$60$5.9K

    Showing 1–10 of 16

    Medicare: Competitive Analysis & Benchmarks

    How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 16 CPT/HCPCS codes.

    View: State1 / 2

    Full comparison — all codes billed, vs. state median

    16 rows

    CPT/HCPCS CodeRankProvider CountMedian ClaimsAvg PaidAverage Revenue
    J01781860440$690$488.1K
    6702819110310$80$43.7K
    67042172020$870$20.8K
    6704182020$960$20.2K
    J90351070110$50$14.5K
    992146,7159,80080$70$9.2K
    6722821030$240$7.3K
    6721021020$360$6.4K
    920121716050$60$5.1K
    921342260060$30$4.7K

    Showing 1–10 of 16

    Related Providers

    Other providers that share a Tax Identification Number (TIN) with Charles Hejny, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Northeast Wisconsin Retina Associates ScWIRetina Specialist (Ophthalmology) Physician$0$2.4M
    Khalid KahookWIRetina Specialist (Ophthalmology) Physician$1.8M$390
    Michael PossinWIRetina Specialist (Ophthalmology) Physician$1.7M$360
    Rajeev BuddiWIRetina Specialist (Ophthalmology) Physician$1.3M$0
    Anthony ParendoWIRetina Specialist (Ophthalmology) Physician$1.2M$0
    Benjamin ErnstWIRetina Specialist (Ophthalmology) Physician$909.7K$0

    Nearby Providers

    Other providers in the same ZIP code as Charles Hejny, ranked by combined Medicare and Medicaid revenue.

    ProviderStateTaxonomyMedicare RevenueMedicaid Revenue
    Thedacare Regional Medical Center-neenah, Inc.WIGeneral Acute Care Hospital$0$18.3M
    Ascension Medical Group-fox Valley Wisconsin, IncWIMulti-Specialty Clinic/Center$0$13.4M
    The Neuroscience Group Of Northeast Wisconsin ScWINeurological Surgery Physician$0$3.9M
    Children's Hospital Of Wisconsin, Inc.WIChildren's Hospital$0$3.4M
    Radiology Associates Of The Fox Valley, ScWIDiagnostic Radiology Physician$0$2.1M
    Bio-medical Applications Of Wisconsin, Inc.WIEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center$0$1.9M
    Neenah Joint School DistrictWILocal Education Agency (LEA)$0$1.6M
    Ministry Home Care, LLC.WICommunity Based Hospice Care Agency$0$1.5M
    Fox Valley Emergency Medicine S.c.WIEmergency Medicine Physician$0$1.5M
    Morton Drug Co IncWILong Term Care Pharmacy$151.3K$438.6K

    Frequently Asked Questions

    References

    1. 1.Medicare Physician & Other Practitioner by Provider and Service. CMS.gov.Provider-level Medicare Part B utilization and payment data.
    2. 2.NPPES NPI Registry. CMS.gov.National Provider Identifier registry used for provider enumeration and taxonomy metadata.

    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.

    Medicare Revenue by CPT/HCPCS Code
    Claims Volume vs. Wisconsin Distribution
    Charles Hejny — 1 of 16 codes billed far more than typical (above p95)
    p5–p95 (all providers)p25–p75MedianThis providerOutlier
    Rank Distribution — Wisconsin