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NPI 1942347703 · Lexington, KY · Retina Specialist (Ophthalmology) Physician
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Todd Purkiss is a retina specialist (ophthalmology) physician provider located in Lexington, Kentucky. This profile covers 13 Medicare and 1 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 | Todd Purkiss |
| Address | 120 N Eagle Creek Dr |
| City | Lexington |
| State | KY |
| ZIP | 40509 |
| Taxonomy | Retina Specialist (Ophthalmology) Physician |
| NPI Enumerated | January 31, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.9M |
| Medicaid | $4.8K |
TODD PURKISS is a retina specialist (Ophthalmology) with an NPI enumerated since 2007-01-31, indicating roughly 19 years of Medicare enrollment and likely sustained clinical presence in Lexington, KY. The tenure supports continuity of care and experience in intravitreal therapeutics and outpatient retina services, consistent with the provider’s CPT/HCPCS mix.
Medicare is the dominant payer by scale for this provider: lifetime Medicare revenue is $3.9M versus Medicaid revenue of $4.8K, indicating an effectively single-payer (Medicare-focused) practice footprint in the available claims data. The Medicaid activity is minimal and concentrated entirely in a single code (92134), so Medicaid does not materially contribute to overall revenue.
Revenue concentration on Medicare is high: the top three Medicare codes by revenue account for 84.8% of the provider’s total Medicare revenue, demonstrating dependence on a few high-value injection drugs and associated procedures. The leading code, J0178, contributes $2.2M (54.6% of Medicare revenue) and, together with J2777 ($981.4K, 24.9%) and J2778 ($208.9K, 5.3%), forms the core revenue stream for this provider.
The clinical/service-line implication is a procedure- and drug-centric retina practice focused on intravitreal anti-VEGF and novel biologic/therapeutic agents. High revenue from J0178 (aflibercept), J2777 (faricimab), and J2778 (ranibizumab), plus notable volume in the intravitreal injection procedure 67028, indicates routine administration of in-office injections and associated follow-up imaging and evaluation services. This mix aligns with a retina specialist whose practice model centers on frequent injection visits supplemented by diagnostic imaging (92134) and E/M visits (99213/99214).
Competitive standing on key Medicare codes is strong: the provider ranks in high national percentiles for several top codes — J0178 is at the 95th percentile (rank #161 of 3204), J2777 at the 88th percentile (rank #241 of 2039), and 67028 at the 92nd percentile (rank #360 of 4255). Those ranks indicate the provider operates at substantially above-typical volume for primary intravitreal therapies and injection procedures relative to national peers, positioning them as a major local center for these services.
There are notable statistical outliers in utilization relative to national peers for certain services: 92134 (diagnostic retinal imaging) is described as an "extreme outlier, far above typical national volume" and ranks at the 99th percentile (rank #285 of 26868), and 99213 is similarly an "extreme outlier, far above typical national volume" at the 99th percentile (rank #5725 of 457151). These labels suggest unusually high use of retinal imaging and established-patient office visits compared with national norms, reinforcing the pattern of frequent follow-up and monitoring in this practice.
Medicaid billing is narrowly focused and modest in scale: all Medicaid revenue ($4.8K) is attributed to 92134 (retinal imaging), which ranks #42 of 74 providers in-state (44th percentile) and is characterized as typical, unremarkable volume among Kentucky peers. This contrast—Medicare imaging volumes being extreme outliers while Medicaid imaging volumes are typical—suggests the provider’s imaging services are primarily utilized by Medicare beneficiaries rather than Medicaid patients.
Beyond injections and imaging, the practice generates ancillary revenue from evaluation and management codes: 99214 and 99213 together account for a meaningful share of Medicare revenue (combined ~3.3% with $72.7K and $60.8K respectively) and both have high national percentiles (99214 at the 96th and 99213 at the 99th). This mix indicates substantial office-based care workload in addition to procedure-driven encounters, consistent with a high-volume retina clinic managing chronic retinal disease with frequent visits.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
13 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 3,130 | $690 | $2.2M |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 33,840 | $30 | $981.4K |
| J2778 | Injection, ranibizumab, 0.1 mg | 1,170 | $180 | $208.9K |
| 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. | 2,080 | $90 | $183.4K |
| 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. | 3,310 | $30 | $89.2K |
| J3490 | Unclassified drugs | 50 | $1,760 | $82.6K |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 630 | $120 | $75.7K |
| 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… | 780 | $90 | $72.7K |
| 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… | 1,050 | $60 | $60.8K |
| 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… | 110 | $120 | $13.3K |
Showing 1–10 of 13
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
13 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 4 | 40 | 870 | $690 | $858.5K |
| J2777 | 3 | 30 | 11,040 | $30 | $399.1K |
| J2778 | 4 | 20 | 700 | $180 | $148.3K |
| 67028 | 4 | 50 | 650 | $90 | $72.9K |
| J2781 | 1 | 10 | 380 | $120 | $48.4K |
| J3490 | 10 | 10 | 50 | $370 | $27.2K |
| J3590 | 28 | 40 | 160 | $60 | $17K |
| 99214 | 204 | 7,230 | 110 | $70 | $14.1K |
| 99213 | 51 | 7,250 | 80 | $50 | $7.7K |
| 92134 | 4 | 410 | 50 | $30 | $6.3K |
Showing 1–10 of 13
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.
1 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 160 | $30 | $4.7K |
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 42 | 70 | 210 | $20 | $29.2K |
Other providers in the same ZIP code as Todd Purkiss, ranked by combined Medicare and Medicaid revenue.
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