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NPI 1992117014 · Philadelphia, PA · Ophthalmology Physician
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Duo Xu is a ophthalmology physician provider located in Philadelphia, Pennsylvania. This profile covers 24 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 | Duo Xu |
| Address | 840 Walnut St Ste 1020 |
| City | Philadelphia |
| State | PA |
| ZIP | 19107 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | May 22, 2014 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $5.3M |
| Medicaid | $300 |
DUO XU is an Ophthalmology Physician in PHILADELPHIA, PA with Total Medicare revenue: $5.3M versus Total Medicaid revenue: $300, indicating an overwhelmingly Medicare‑dependent billing footprint and effectively single‑payer scale concentrated in Medicare. The provider’s NPI was enumerated 2014-05-22 (~12 years ago), signaling an established practice tenure that has built a high Medicare volume over time.
Revenue concentration is extreme on Medicare: the precomputed top 3 codes account for 80.1% of this provider's total Medicare revenue, driven by J0178 ($2.4M, 45.8% of Medicare revenue), Q5128 ($916.1K, 17.4%), and J2778 ($886K, 16.8%). This code mix shows that a very small number of drug administration codes dominate the practice’s billed Medicare dollars.
Clinical/service-line implication: the billing mix (heavy volumes and revenue from J0178, J2778 and Q5128) indicates the practice operates primarily as a high‑throughput medical retina/intravitreal injection service administering anti‑VEGF agents. Supporting services such as intravitreal injection procedure 67028 (3.2K claims, $309.5K, 5.9% of Medicare revenue) and retinal imaging 92134 (4.9K claims, $152.6K, 2.9%) further reinforce an outpatient retina treatment and diagnostics model rather than a surgery‑first practice.
Volume and operational intensity are substantial: the provider reports 3.5K claims for J0178 and 4.7K claims for J2778 alongside 4.9K claims for 92134, with 92134 flagged as an "extreme outlier." Both J0178 and J2778 rank in high national percentiles (J0178: 97th percentile, notably above typical; J2778: 96th percentile, notably above typical), which points to a concentrated, high‑frequency injection workflow.
Competitive standing varies by code: for Medicare this provider is a major national participant on its top drug codes (e.g., Q5128 ranks #19 of 373 providers nationally, 95th percentile, and J0178 ranks #112 of 3204, 97th percentile), while for Medicaid the single Medicaid code (92134) accounts for 100.0% of Medicaid revenue but ranks #174 of 183 in‑state (0th percentile; typical, unremarkable), indicating minimal Medicaid market presence.
Surgical retina and complex procedure contribution is present but limited: vitrectomy and retinal repair codes such as 67042 (32 claims, $28.8K), 67113 (24 claims, $25.3K) and 67108 (21 claims, $20.1K) are reported at modest volumes and typical percentiles, suggesting the practice performs some surgical cases but is not primarily a surgical retina center.
Payer mix and financial risk implications: with Total Medicare revenue: $5.3M versus Total Medicaid revenue: $300 and the top 3 Medicare codes representing 80.1% of Medicare dollars, the provider’s revenue is highly concentrated in physician‑administered injectable therapies billed to Medicare. This concentration implies that drug reimbursement and administration rates for these specific HCPCS codes will materially drive the provider’s financial performance and payer negotiations.
Operational risk and utilization signals for payers: several codes are labeled as "notably above typical" or an "extreme outlier" (for example, J0178 and 92134), which should prompt payers to examine utilization patterns, site‑of‑service documentation, and care pathways given the high throughput of intravitreal injections and retinal imaging relative to national peers. These patterns are consistent with a specialized, high‑volume retina practice rather than general ophthalmology care.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
24 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 3,480 | $690 | $2.4M |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 4,240 | $220 | $916.1K |
| J2778 | Injection, ranibizumab, 0.1 mg | 4,690 | $190 | $886K |
| 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. | 3,160 | $100 | $309.5K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 6,600 | $30 | $191.4K |
| 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. | 4,920 | $30 | $152.6K |
| 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… | 2,060 | $70 | $138K |
| 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… | 760 | $90 | $65.2K |
| 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… | 460 | $120 | $56.7K |
| 67042 | In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina… | 30 | $900 | $28.8K |
Showing 1–10 of 24
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 24 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
24 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J0178 | 10 | 140 | 830 | $690 | $865.1K |
| Q5128 | 9 | 20 | 3,830 | $220 | $838.7K |
| J2778 | 14 | 70 | 1,030 | $190 | $417.1K |
| J2777 | 56 | 100 | 7,950 | $30 | $360.2K |
| 67028 | 13 | 180 | 600 | $90 | $87.5K |
| J7999 | 48 | 110 | 100 | $120 | $33.3K |
| 67042 | 14 | 50 | 20 | $1,100 | $31.9K |
| 67039 | 3 | 10 | 20 | $1,030 | $21.6K |
| 92014 | 121 | 1,570 | 130 | $80 | $21K |
| 67108 | 10 | 20 | 20 | $910 | $20.1K |
Showing 1–10 of 24
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. | 10 | $30 | $300 |
How this provider's Medicaid billing volume and revenue compare to other Pennsylvania providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Pennsylvania 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. | 174 | 180 | 290 | $20 | $24.8K |
Other providers in the same ZIP code as Duo Xu, ranked by combined Medicare and Medicaid revenue.
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