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 Puerto Rico for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Puerto Rico 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. Puerto Rico (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.

Retina Care Psc (NPI 1982958773)

Key Findings

Field	Value
Entity Type	Organization
Organization	Retina Care Psc
Address	58 Calle Ponce De Leon
City	Arecibo
State	PR
ZIP	00612
Taxonomy	Ophthalmology Physician
NPI Enumerated	November 1, 2012

Payer Source	Total Paid
Medicaid	$4.3M
Medicare	$0

RETINA CARE PSC is effectively a single-payer Medicaid practice: there is no Medicare billing on file and lifetime Medicaid revenue is $4.3M, indicating Medicaid is the sole documented public-payer revenue stream for this provider. This billing profile makes the practice highly dependent on Medicaid volume rather than Medicare fee-for-service payments.

Revenue is highly concentrated in a small set of services: the top three Medicaid codes (67028, 92012, 92134) together account for 60.8% of the provider’s total Medicaid revenue. Individually, 67028 represents $1.1M (25.9%), 92012 represents $798.6K (18.5%), and 92134 represents $708.5K (16.4%) of the $4.3M Medicaid total.

Clinical service mix indicates a retina-focused ophthalmology operation: high revenue and claim counts for intravitreal injection (67028) and bevacizumab-related codes (C9257, J9035), combined with heavy volumes in retinal imaging (92134, 92250) and extended ophthalmoscopy (92202). The presence of both frequent injection codes and multimodal retinal imaging suggests the practice manages chronic retinal disease (e.g., wet AMD/diabetic retinal disease) with ongoing injection therapy and serial imaging.

Competitive standing within Puerto Rico is dominant for several retina-related codes: 67028 ranks #1 of 28 providers in-state (100th percentile; extreme outlier) and 92134 ranks #1 of 83 providers in-state (100th percentile; extreme outlier), while 92012 ranks #7 of 353 providers (98th percentile; extreme outlier). These rankings indicate RETINA CARE PSC is a major statewide provider for intravitreal injections, retinal imaging, and high-volume intermediate eye exams relative to peers.

The practice also shows extreme outlier volumes on several diagnostic and documentation items beyond the top three: 92226 (12K claims) ranks #1 of 82 providers in-state (100th percentile; extreme outlier), 92250 (7.1K claims) ranks #6 of 156 providers (97th percentile; extreme outlier), and 92202 (12.6K claims) ranks #1 of 88 providers (100th percentile; extreme outlier). These data points reinforce that RETINA CARE PSC performs disproportionately large volumes of posterior-segment diagnostics and ophthalmoscopic services compared with other in-state providers.

The provider offers some procedural retinal surgery and laser services but at far lower volumes: 67039 (vitrectomy) appears 62 claims for $98.6K (ranks #3 of 3 providers), while laser codes 67210 and 67228 generate meaningful revenue ($395.2K and $169.8K respectively) but sit at more typical state percentiles (67210 rank #3 of 10, 78th percentile; 67228 rank #3 of 12, 82th percentile). This pattern is consistent with a practice that focuses primarily on clinic-based injections and imaging with a smaller surgical caseload.

Two diabetes-related documentation codes show high claim counts but no paid revenue: 2023F (1.4K claims, $0 avg paid) ranks #1 of 16 providers in-state (100th percentile) and 2022F (1.7K claims, $0 avg paid) ranks #2 of 49 providers in-state (98th percentile). These entries indicate routine dilated retinal exam reporting for diabetic patients is being recorded at high frequency but does not generate Medicaid payments in these line items, which is important for interpreting utilization versus reimbursement.

The provider has an established operational history, with NPI enumeration on 2012-11-01 (~14 years ago), supporting the interpretation that current high Medicaid volumes reflect multi-year practice stability rather than a short-term billing spike. Combined with the $4.3M lifetime Medicaid revenue and concentrated retina-focused service mix, this tenure suggests a sustained, Medicaid-centric retinal specialty practice in Puerto Rico.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

18 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	9,500	$120	$1.1M
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…	17,360	$50	$798.6K
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.	29,520	$20	$708.5K
67210	The provider destroys a lesion of the retina using a laser beam that heats up the tissue.	1,070	$370	$395.2K
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…	3,000	$90	$272.8K
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…	12,610	$20	$189.1K
67228	In 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…	340	$500	$169.8K
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,…	7,140	$20	$149.9K
92002	The provider performs an intermediate level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program.	2,590	$40	$111.3K
92226	N/A	11,960	$10	$107.6K

Showing 1–10 of 18

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Puerto Rico providers billing the same CPT/HCPCS codes.

Claims Volume vs. Puerto Rico Distribution

Retina Care Psc — 8 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Puerto Rico

Full comparison — all codes billed, vs. Puerto Rico median

18 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J9035	Injection, bevacizumab, 10 mg	6	20	370	$2,820	$2.3M
67210	The provider destroys a lesion of the retina using a laser beam that heats up the tissue.	3	10	90	$370	$235.2K
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.	1	30	1,090	$130	$222.2K
67228	In 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…	3	10	110	$510	$153.3K
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…	7	350	540	$50	$96.4K
67039	The provider removes vitreous humor from the eye to access the posterior segment of the eye and introduce surgical instruments through incisions in the pars plana. This procedure also includes the…	3	10	90	$960	$77.6K
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…	8	120	180	$80	$62.9K
C9257	Injection, bevacizumab, 0.25 mg	1	20	350	$50	$61.8K
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.	1	80	650	$20	$43.1K
92002	The provider performs an intermediate level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program.	43	440	370	$40	$38.5K

Showing 1–10 of 18

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sociedad De Servicios Neonatales De Arecibo	PR	Neonatal-Perinatal Medicine Physician	$0	$14.3M
Laboratorio Clinico Toledo, LLC	PR	Clinical Medical Laboratory	$83.2K	$11.9M
Metro Pavia At Home, LLC	PR	Home Health Agency	$0	$6.6M
Hospicio La Paz Inc	PR	Community Based Hospice Care Agency	$0	$5.7M
Integral Therapy Center	PR	Hearing and Speech Clinic/Center	$0	$3.8M
Luis Montalvo	PR	Ophthalmology Physician	$8K	$3.5M
Laboratorio Clinico Villa Los Santos	PR	Clinical Medical Laboratory	$360	$3.1M
Emergency Physician Providers, LLC	PR	Emergency Medical Services (Emergency Medicine) Physician	$0	$2.8M
Arraiza Radiology Psc	PR	Diagnostic Radiology Physician	$0	$2.8M
Instituto Del Cancer Y Enfermedades De La Sangre, Csp	PR	Hematology & Oncology Physician	$0	$2.8M

Retina Care Psc — Billing Profile & Reimbursement Data

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Retina Care Psc — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References