Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Maryland for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Maryland only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Maryland (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Michael Lai (NPI 1962432260)

Field	Value
Entity Type	Individual
Organization	Michael Lai
Address	5454 Wisconsin Ave Ste 650
City	Chevy Chase
State	MD
ZIP	20815
Taxonomy	Retina Specialist (Ophthalmology) Physician
NPI Enumerated	July 3, 2006

Payer Source	Total Paid
Medicare	$4.2M
Medicaid	$0

Key Findings

This provider is a retina specialist whose Medicare billing profile is dominated by intravitreal drug therapy and retina-focused diagnostics. The single largest revenue driver is J0178 (aflibercept) at $2.2M and 52.2% of Medicare revenue, supplemented by J2778 (ranibizumab) at $415.9K and procedure code 67028 (vitreous injection) at $234.9K, reflecting an operational focus on high-volume anti‑VEGF injections and injection procedures. 92014 (comprehensive established patient eye exam) at $420.1K and 92134 (retinal imaging) at $143.2K indicate substantial clinic and imaging throughput supporting that treatment mix.

Revenue concentration is high: the top three Medicare codes account for 72.2% of the provider’s Medicare revenue, with a single code, J0178, representing 52.2% of the $4.2M in Medicare receipts. That level of concentration signals that changes in drug utilization, reimbursement, or prescribing patterns for aflibercept would materially affect the provider’s revenue.

This provider’s payer mix is effectively single-payer at present: Medicare revenue totals $4.2M while there is no Medicaid billing on file. Analysts should treat Medicaid as absent from the current revenue picture and focus benchmarking and utilization review primarily against Medicare peers.

On competitive standing, several codes show unusually high national volume relative to peers: 92014 ranks #15 of 35415 providers (100th percentile; extreme outlier) and 92134 ranks #134 of 26868 providers (100th percentile; extreme outlier), indicating this clinician runs an exceptionally high-volume clinic for both comprehensive visits and retinal imaging. J0178 ranks #154 of 3204 providers (95th percentile; notably above typical national volume), and 67028 ranks #318 of 4255 providers (93th percentile; notably above typical national volume), which together position the provider as a major national-volume injector for retina therapies.

Some high-volume codes show atypical unit economics: J2777 (faricimab) appears with 7.3K claims but a low $27 avg paid/claim and $196K revenue (4.7% of Medicare revenue), and J2778 (ranibizumab) contributes $415.9K (10.0%). These entries indicate substantial claim counts for newer or alternate biologics with lower average payments per claim compared with J0178, and they merit attention to coding patterns and claim granularity when benchmarking utilization and cost per treatment episode.

Use of unclassified and compound drug codes is materially visible in the revenue mix: J3590 produced $256.5K (6.1%) and J3490 produced $105.8K (2.5%), while the biosimilar Q5128 contributed $139.1K (3.3%). This suggests the practice bills a meaningful share of drug-related revenue under unclassified or biosimilar codes, so payers should review those line items for clinical and reimbursement classification when assessing drug spend.

The provider has long tenure in Medicare enrollment (NPI enumerated 2006-07-03, ~20 years ago), consistent with an established clinical operation that appears to have scaled high-volume injection and imaging services over time. That longevity combined with the high-percentile volumes for core retina codes supports a profile of a mature, procedure-intensive retina practice.

For payers and contracting teams, the combination of Medicare dominance, heavy reliance on a single high-revenue drug code (J0178), and extreme outlier volumes for office and imaging codes (92014 and 92134) identifies this clinician as a strategic high-utilizer of anti‑VEGF therapy and retinal diagnostics; monitoring utilization trends for J0178 and associated injection/visit codes should be prioritized in network management and medical-cost oversight.

Medicare: Complete Services Breakdown

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

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J0178	Injection, aflibercept, 1 mg	3,180	$690	$2.2M
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…	4,040	$100	$420.1K
J2778	Injection, ranibizumab, 0.1 mg	2,210	$190	$415.9K
J3590	Unclassified biologics	100	$2,470	$256.5K
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.	2,160	$110	$234.9K
J2777	Injection, faricimab‑svoa, 0.1 mg	7,260	$30	$196K
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.	3,980	$40	$143.2K
Q5128	Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg	650	$220	$139.1K
J3490	Unclassified drugs	60	$1,790	$105.8K
92202	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…	2,700	$10	$35K

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

Claims Volume vs. Maryland Distribution

Michael Lai — 3 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maryland

Full comparison — all codes billed, vs. state median

16 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J0178	9	100	950	$690	$887.3K
J2777	39	70	8,520	$30	$487.3K
J2778	7	50	650	$180	$207.8K
J3590	2	20	50	$2,390	$128.9K
67028	18	120	700	$100	$101.5K
Q5128	2	20	200	$210	$78K
J3490	58	100	70	$450	$62.1K
92014	4	620	210	$90	$44K
92235	69	90	70	$110	$19.5K
92134	9	490	110	$30	$17.3K

Showing 1–10 of 16

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
The Retina Group Of Washington, PLLC	MD	Ophthalmology Physician	$0	$19.5M
Virginia Oncology Associates	VA	Hematology & Oncology Physician	$0	$6.2M
Rohit Lakhanpal	MD	Retina Specialist (Ophthalmology) Physician	$6.1M	$0
Gordon Byrnes	VA	Retina Specialist (Ophthalmology) Physician	$4.9M	$0
Daniel Berinstein	MD	Retina Specialist (Ophthalmology) Physician	$4.3M	$0
Alexander Melamud	VA	Retina Specialist (Ophthalmology) Physician	$4.2M	$0
Jordana Fein	VA	Retina Specialist (Ophthalmology) Physician	$4.2M	$0
Eric Weichel	MD	Ophthalmology Physician	$4.1M	$0
Gayatri Reilly	MD	Retina Specialist (Ophthalmology) Physician	$4.1M	$0
Sundeep Kasi	VA	Retina Specialist (Ophthalmology) Physician	$4.1M	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Frederick Smith	MD	Medical Oncology Physician	$2.7M	$0
Richard Garfinkel	MD	Retina Specialist (Ophthalmology) Physician	$2.4M	$0
John Schreiber	MD	Diagnostic Radiology Physician	$2.3M	$0
Friendship Ambulatory Surgery Center, LLC	MD	Ambulatory Surgical Clinic/Center	$2.2M	$0
David Weng	MD	Medical Oncology Physician	$1.5M	$0
Hyland Cronin	MD	Dermatology Physician	$1.5M	$0
David Wolfe	MD	Rheumatology Physician	$1.4M	$0
Brian Do	MD	Retina Specialist (Ophthalmology) Physician	$1.2M	$0
Metropolitan Medical Partners LLC	MD	Ambulatory Surgical Clinic/Center	$1.2M	$0
Maral Skelsey	MD	Dermatology Physician	$1.1M	$0

Michael Lai — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References