Physician
Raul Adrian Pena MD PA
Raul Adrian Pena MD PA was paid $111K by Medicaid between Jan 2018 and Aug 2024, across 27 billing codes. Its largest line is 92012, Ophthalmological services: medical examination and evaluation, intermediate, established patient — 37% of everything it billed.
33Billing provider infoRAUL ADRIAN PENA MD PA
MCALLEN, TX 78503
MCALLEN, TX 78503
33aNPI1407037633assigned 11/15/2007
33bProvider typeOphthalmology Physician
28Total paid$111K
24GClaims30,072
24DCodes billed27
24AFirst – last monthJan 2018 – Aug 2024
Compared with peers
Next to other Ophthalmology Physician providers in Texas
Rank by total paid#50 of 231
Median peer was paid$16K
This provider vs. median7.1×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 12,842 | $23K | |
| 2019 | 9,852 | $9K | |
| 2020 | 2,074 | $11K | |
| 2021 | 1,702 | $41K | |
| 2022 | 3,332 | $20K | |
| 2023 | 216 | $5K | |
| 2024incomplete | 54 | $1K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 92012 | Ophthalmological services: medical examination and evaluation, intermediate, established patient | 37% | 3,005 | 2,808 | $41K |
| 92014 | Ophthalmological services: medical examination and evaluation, comprehensive, established patient | 36% | 1,751 | 1,680 | $40K |
| S0621 | Routine ophthalmological examination including refraction; established patient | 16% | 425 | 409 | $17K |
| 99204 | Doctor's office visit, new patient (more involved)Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity | 8.1% | 280 | 271 | $9K |
| 92133 | 1.9% | 176 | 170 | $2K | |
| 92136 | <1% | 78 | 42 | $718.99 | |
| 92015 | Determination of refractive state | <1% | 112 | 103 | $313.90 |
| 66984 | Extracapsular cataract removal with insertion of intraocular lens prosthesis | <1% | 24 | 16 | $161.52 |
| 66821 | <1% | 17 | 12 | $28.90 | |
| 1036F | 0% | 3,498 | 3,330 | $0.00 | |
| G9903 | Patient screened for tobacco use and identified as a tobacco non-user | 0% | 2,501 | 2,444 | $0.00 |
| G8756 | No documentation of blood pressure measurement, reason not given | 0% | 2,418 | 2,302 | $0.00 |
15 more codes
| 3285F | 0% | 728 | $0.00 | |
| G8397 | Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy | 0% | 101 | $0.00 |
| 3284F | 0% | 728 | $0.00 | |
| 3072F | 0% | 37 | $0.00 | |
| G8427 | Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications | 0% | 3,676 | $0.00 |
| G8785 | Blood pressure reading not documented, reason not given | 0% | 1,015 | $0.00 |
| 2027F | 0% | 970 | $0.00 | |
| 4040F | 0% | 2,303 | $0.00 | |
| G9744 | Patient not eligible due to active diagnosis of hypertension | 0% | 2,353 | $0.00 |
| G8482 | Influenza immunization administered or previously received | 0% | 1,567 | $0.00 |
| 0517F | 0% | 1,101 | $0.00 | |
| 2024F | 0% | 368 | $0.00 | |
| 2026F | 0% | 369 | $0.00 | |
| 5010F | 0% | 101 | $0.00 | |
| 2022F | 0% | 370 | $0.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialPENA, RAUL (OWNER)