Loading...
NPI 1932134491 · New York, NY · Specialist
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
James Klancnik is a specialist provider located in New York, New York. This profile covers 12 Medicare and 7 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 | James Klancnik |
| Address | 950 Third Avenue |
| City | New York |
| State | NY |
| ZIP | 10022 |
| Taxonomy | Specialist |
| NPI Enumerated | July 12, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.2M |
| Medicaid | $175.2K |
Practice profile and procedure mix: Billing is dominated by intravitreal pharmacologic therapy and retina-focused services, with high-volume anti-VEGF drug codes J0178, J2777 and J2778 at the top of the Medicare list and frequent use of injection procedure 67028 plus retina imaging codes 92134 and 92250. The code mix (drug injections, injection procedure, retinal imaging and intermediate/comprehensive ophthalmologic exams) is consistent with a retina specialist or retina-focused ophthalmology practice that delivers recurring, procedure-driven care to patients.
Medicare revenue concentration: The provider’s Medicare revenue is heavily concentrated in its top injectable drugs — J0178 (52.9%), J2777 (18.2%) and J2778 (13.4%) together account for 84.5% of this provider's total Medicare revenue. This concentration indicates a small set of high-cost drug and injection services drive the majority of Medicare revenue.
Medicare competitive standing and outlier signals: The provider ranks strongly on several high-revenue Medicare codes, including J0178 (rank #155 of 3204, 95th percentile; notably above typical national volume) and J2778 (rank #106 of 1208, 91th percentile), while retina-related services such as 92012 (rank #57 of 17177, 100th percentile; extreme outlier) and 92134 (rank #419 of 26868, 98th percentile; extreme outlier) are far above typical national volume. These positions suggest the provider is a major national-volume participant for aflibercept and retinal imaging relative to peers, and that routine follow-up and imaging volumes are unusually high.
Medicaid concentration and standing: On Medicaid the same drug codes dominate even more of the small Medicaid revenue base — J0178 (62.1%), J2777 (24.9%) and 67028 (8.7%) together make up 95.8% of this provider's total Medicaid revenue. However, in-state ranks for these codes are modest or typical (for example, J0178 ranks #52 of 101 in-state, 49th percentile; J2777 ranks #10 of 15, 36th percentile), indicating Medicaid activity is not unusually concentrated relative to state peers despite the top-code dominance within this provider's Medicaid revenue.
Payer mix and scale: This provider is effectively Medicare-dominant in scale, with $4.2M in total Medicare revenue versus $175.2K in total Medicaid revenue. Medicaid exists on the billing profile but represents a small fraction of total public-payer revenue, so payer strategies and financial risk are primarily driven by Medicare volumes and reimbursements.
Operational implications for contracting and utilization focus: Given that J0178, J2777 and J2778 capture the bulk of Medicare revenue and similar drugs capture most Medicaid revenue, payers should prioritize contract terms, drug acquisition and utilization management for these injectable agents and related injection procedures (67028). The concurrent high volumes of retinal imaging (92134, 92250) and follow-up exams (92012) imply frequent recurring visits per patient, which magnifies the financial impact of any utilization or price variance in those drug codes.
Tenure and market presence: The provider’s NPI was enumerated on 2006-07-12 (~20 years ago), indicating a long-standing practice presence. Combined with the high national ranks on key retina and injection codes, the tenure supports an established, procedure-centric retinal practice rather than a new entrant.
Implications for risk adjustment and monitoring: The extreme outlier labels on several diagnostic and exam codes (for example, 92012 and 92134 marked as extreme outliers) and the heavy reliance on a few high-cost drug codes means monitoring should focus on appropriate documentation of retina disease management, treatment intervals for intravitreal injections, and alignment of imaging/exam frequency with clinical guidelines. Medicaid volumes do not show similar outlier behavior in-state, which suggests payer-specific reviews may be more relevant to Medicare contracting and utilization oversight.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
12 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 3,180 | $690 | $2.2M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 26,100 | $30 | $756.9K |
| J2778 | Injection, ranibizumab, 0.1 mg | 3,120 | $180 | $557.9K |
| 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. | 2,120 | $110 | $241.9K |
| 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… | 2,210 | $80 | $172.5K |
| 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. | 2,970 | $40 | $104.1K |
| 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… | 560 | $110 | $58.8K |
| 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,… | 1,130 | $30 | $37.2K |
| 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. | 220 | $120 | $27.4K |
| 76512 | The provider uses B–scan ultrasound imaging, with or without a non–qualitative A–scan superimposed, to examine the intraocular and orbital structures. | 40 | $50 | $1.6K |
Showing 1–10 of 12
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 12 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
12 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 13 | 230 | 560 | $690 | $693K |
| J2777 | 12 | 120 | 7,740 | $30 | $364.9K |
| J2778 | 1 | 70 | 510 | $180 | $131.6K |
| 67028 | 15 | 300 | 400 | $100 | $65.9K |
| 92014 | 378 | 2,220 | 160 | $100 | $29.3K |
| 92012 | 9 | 1,640 | 100 | $70 | $17.4K |
| 92134 | 24 | 1,580 | 90 | $30 | $11.2K |
| 92004 | 95 | 1,750 | 50 | $110 | $9.2K |
| 76512 | 204 | 340 | 50 | $50 | $6.6K |
| 92250 | 30 | 1,700 | 80 | $30 | $5.2K |
Showing 1–10 of 12
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.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 250 | $430 | $108.6K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 80 | $530 | $43.6K |
| 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. | 700 | $20 | $15.3K |
| 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… | 180 | $20 | $3.7K |
| 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. | 310 | $10 | $2.8K |
| 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,… | 50 | $20 | $900 |
| 92201 | 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… | 20 | $1 | $20 |
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
7 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 52 | 100 | 280 | $650 | $369.9K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 10 | 20 | 120 | $720 | $173.2K |
| 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… | 843 | 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. | 102 | 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,… | 1,180 | 1,490 | 340 | $40 | $48.7K |
| 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. | 395 | 730 | 370 | $20 | $30K |
| 92201 | 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… | 284 | 320 | 190 | $20 | $10.7K |
Other providers in the same ZIP code as James Klancnik, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Ali Aboufares | NY | Interventional Cardiology Physician | $1.3M | $2.1M |
| Wayne Fuchs | NY | Ophthalmology Physician | $1.7M | $0 |
| Brian Apatoff | NY | Neurology Physician | $708.5K | $0 |
| Ramon Valderrama | NY | Neurology Physician | $293.2K | $297.4K |
| David Bolon | NY | Cardiovascular Disease Physician | $508.4K | $350 |
| Roy Geronemus | NY | Specialist | $472.2K | $0 |
| Brian Gelbman | NY | Pulmonary Disease Physician | $426.3K | $0 |
| Alan Manevitz | NY | Psychiatry Physician | $397.9K | $0 |
| Clark Huang | NY | Specialist | $390K | $0 |
| Jacqueline Beer | NY | Specialist | $388.5K | $0 |
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.