Sumsion, Michael

Sumsion, Michael was paid $779K by Medicaid between Jan 2018 and Jul 2023, across 17 billing codes. Its largest line is J0178, Injection, aflibercept, 1 mg — 64% of everything it billed.

33Billing provider infoSUMSION, MICHAEL
REDDING, CA 96001

33aNPI1699725507assigned 05/11/2006

33bProvider typeOphthalmology Physician

28Total paid$779K

24GClaims8,469

24DCodes billed17

24AFirst – last monthJan 2018 – Jul 2023

Compared with peers

Next to other Ophthalmology Physician providers in California

Rank by total paid#98 of 759

Median peer was paid$35K

This provider vs. median22×

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	948	$25K
2019	1,372	$90K
2020	738	$19K
2021	1,148	$28K
2022	2,388	$289K
2023	1,875	$327K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
J0178	Injection, aflibercept, 1 mg	64%	673	547	$498K
67028	Intravitreal injection of a pharmacologic agent	18%	899	736	$138K
92134		9.1%	3,327	2,878	$70K
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	3.8%	437	434	$29K
99214	Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	1.8%	510	501	$14K
99213	Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity	1.1%	475	450	$8K
92012	Ophthalmological services: medical examination and evaluation, intermediate, established patient	<1%	501	465	$6K
83861		<1%	589	348	$4K
92014	Ophthalmological services: medical examination and evaluation, comprehensive, established patient	<1%	236	235	$2K
92015	Determination of refractive state	<1%	128	128	$2K
83516		<1%	452	283	$1K
92083		<1%	62	62	$1K

5 more codes

99212	Office or other outpatient visit for the evaluation and management of an established patient, straightforward	<1%	51	$1K
92133		<1%	53	$1K
92136		<1%	49	$1K
99203	Doctor's office visit, new patient (routine)	<1%	15	$915.20
92499		<1%	12	$65.82

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.