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NPI 1932217262 · Washington, DC · Ophthalmology Physician
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Theodore Gancayco is a ophthalmology physician provider located in Washington, District of Columbia. This profile covers 15 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 | Theodore Gancayco |
| Address | 1160 Varnum St Ne Ste 11 |
| City | Washington |
| State | DC |
| ZIP | 20017 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | August 28, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $479.4K |
| Medicaid | $87K |
Medicare is the dominant revenue source for this ophthalmologist, with total Medicare revenue of $479.4K compared with $87K in Medicaid revenue; both payers are present but Medicare accounts for the bulk of lifetime billings on file. This scale difference indicates the provider’s practice is more Medicare‑facing in volume and revenue generation rather than Medicaid‑dependent.
Medicare revenue is highly concentrated in a small set of services: the precomputed top three Medicare codes (99214, J0178, 99213) account for 69.7% of the provider’s total Medicare revenue. Specifically, 99214 alone generated $223.4K (46.5% of Medicare revenue), J0178 generated $64.3K (13.4%), and 99213 generated $47.1K (9.8%), which points to a heavy reliance on office E/M visits plus intravitreal therapy.
The specific Medicare code mix (high revenue from 99214 and 99213 alongside J0178) suggests an office-based ophthalmology practice that manages medical retina and complex outpatient visits; frequent use of advanced diagnostics is corroborated by high-volume imaging codes on the Medicare side. High counts for 92083, 92250, and 92133 alongside E/M and injection codes indicate sustained investment in visual field testing, fundus photography, and OCT imaging consistent with retina/glaucoma workflows and monitoring.
On Medicare competitive standing, the provider is an extreme outlier nationally for some high-volume diagnostic/E/M codes and imaging services: 99214 ranks #901 of 479517 (100th percentile; extreme outlier) and 92083 ranks #294 of 25484 (99th percentile; extreme outlier), while 99213 ranks #16397 of 457151 (96th percentile; notably above typical). By contrast, J0178 is characterized as typical/unremarkable within its national peer set (rank #3013 of 3204, 6th percentile), so the practice’s high Medicare revenue is driven more by very large E/M and diagnostic volumes than by being a nationally prominent aflibercept injector.
Medicaid revenue shows an even tighter concentration: the precomputed top three Medicaid codes (92014, 99213, 92083) account for 83.5% of the provider’s total Medicaid revenue. Within Medicaid, 92014 contributed $33.3K (38.1%), 99213 contributed $31.9K (36.5%), and 92083 contributed $7.8K (8.9%), indicating the Medicaid population is driven primarily by comprehensive established eye exams and lower‑level E/M services rather than injection therapy.
Statewide competitive standing on Medicaid is modest: 92014 ranks #33 of 51 in-state (36th percentile; typical, unremarkable), 99213 ranks #175 of 316 (45th percentile; typical, unremarkable), and 92083 ranks #14 of 19 (28th percentile; typical, unremarkable). These ranks indicate the provider is not a leading Medicaid volume player in Washington, DC, and competes at a mid-to-low level among in-state peers for the same codes.
The provider’s billing footprint also highlights operational implications: consistently high volumes of imaging codes (92250, 92133, 92134) and visual field testing (92083) on Medicare imply on-site diagnostic capability and throughput capacity, while repeated billing for intravitreal procedures (67028, J0178, J9035) indicates routine office-based injection services. Together, these patterns suggest capital and staffing aligned to support frequent testing and in-office therapeutic procedures rather than a purely surgical practice model.
The provider has long tenure on file, with an NPI enumerated on 2006-08-28 (~20 years ago), which supports the observed sustained billing patterns across Medicare and Medicaid. This longevity, combined with concentrated revenue in a few high-volume codes, suggests an established patient panel and a stable clinical focus centered on medical ophthalmology and diagnostic imaging capacity.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
15 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 2,210 | $100 | $223.4K |
| J0178 | Injection, aflibercept, 1 mg | 90 | $680 | $64.3K |
| 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… | 650 | $70 | $47.1K |
| 92083 | The provider may use one or more methods to determine the extent of a patient's visual field of one or both eyes; he interprets the results and prepares a report. Report this code for an extended… | 680 | $50 | $35.1K |
| 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,… | 900 | $30 | $27.9K |
| 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. | 170 | $100 | $16K |
| 92133 | The provider performs computerized diagnostic imaging of the optic nerve in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both… | 530 | $30 | $15.4K |
| 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… | 100 | $130 | $12.5K |
| 92020 | The provider examines the angle of the anterior chamber of the eye (the angle where the iris and cornea meet) using a special lens (goniolens) and slit–lamp or operating microscope to diagnose and… | 490 | $20 | $11.3K |
| 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. | 330 | $30 | $11K |
Showing 1–10 of 15
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 15 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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 |
|---|---|---|---|---|
| 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… | 280 | $120 | $33.3K |
| 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… | 410 | $80 | $31.9K |
| 92083 | The provider may use one or more methods to determine the extent of a patient's visual field of one or both eyes; he interprets the results and prepares a report. Report this code for an extended… | 140 | $60 | $7.8K |
| 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,… | 130 | $40 | $4.6K |
| 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… | 40 | $110 | $4.6K |
| 99212 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,… | 100 | $40 | $4.4K |
| 92020 | The provider examines the angle of the anterior chamber of the eye (the angle where the iris and cornea meet) using a special lens (goniolens) and slit–lamp or operating microscope to diagnose and… | 30 | $30 | $700 |
How this provider's Medicaid billing volume and revenue compare to other District of Columbia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. District of Columbia median
7 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99212 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,… | 81 | 130 | 290 | $140 | $579.2K |
| 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… | 269 | 310 | 750 | $70 | $321.6K |
| 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… | 175 | 320 | 620 | $50 | $313.6K |
| 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… | 33 | 50 | 720 | $60 | $80.7K |
| 92083 | The provider may use one or more methods to determine the extent of a patient's visual field of one or both eyes; he interprets the results and prepares a report. Report this code for an extended… | 14 | 20 | 740 | $30 | $58.7K |
| 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,… | 18 | 20 | 510 | $30 | $50.2K |
| 92020 | The provider examines the angle of the anterior chamber of the eye (the angle where the iris and cornea meet) using a special lens (goniolens) and slit–lamp or operating microscope to diagnose and… | 13 | 20 | 240 | $10 | $11.6K |
Other providers in the same ZIP code as Theodore Gancayco, ranked by combined Medicare and Medicaid revenue.
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