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NPI 1033213269 · Sandwich, MA · Ambulatory Surgical Clinic/Center
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Cape Cod Eye Surgery & Laser Center, LLC is a ambulatory surgical clinic/center provider located in Sandwich, Massachusetts. This profile covers 22 Medicare and 2 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 | Organization |
| Organization | Cape Cod Eye Surgery & Laser Center, LLC |
| Address | 282 Route 130 |
| City | Sandwich |
| State | MA |
| ZIP | 02563 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | September 8, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.5M |
| Medicaid | $238.2K |
The practice is functionally an ophthalmic ambulatory surgical center with a heavy procedural focus on cataract surgery: code 66984 alone generated $2.2M and represents 63.1% of the provider's Medicare revenue, and 66984 also accounts for $237.6K (100.0% of this provider's Medicaid revenue), indicating that routine cataract extraction with lens insertion is the dominant service line across payers. The prevalence of high-revenue cataract codes combined with numerous anterior-segment procedures supports an ASC model rather than a general outpatient clinic.
Medicare revenue is concentrated in a very small set of procedures: precomputed data show the top 3 Medicare codes by revenue account for 77.3% of this provider's total Medicare revenue, led by 66984 ($2.2M, 63.1%), followed by 66991 ($340.9K, 9.7%) and 67042 ($156.7K, 4.5%). This concentration means the facility’s financial performance is tightly linked to cataract and related intraocular procedures listed among those top three codes.
On Medicaid the provider is effectively single‑code dependent: precomputed data show the top 3 Medicaid codes by revenue account for 100.0% of Medicaid revenue, with Medicaid billing dominated by 66984 (861 claims, $276 avg paid/claim, $237.6K). Medicaid scale is small compared with Medicare — total Medicare revenue is $3.5M versus total Medicaid revenue of $238.2K — so payers and analysts should treat Medicaid exposure as limited and concentrated.
Competitive standing for key Medicare procedures is strong: 66984 ranks #742 of 15965 providers nationally (95th percentile) and is described as "notably above typical national volume," while 66991 ranks #37 of 1445 (98th percentile) and 67042 ranks #32 of 1087 (97th percentile), both also "notably above typical national volume." These rank/percentile positions indicate the provider operates at high national volume for several advanced ophthalmic procedures, positioning it as a regional leader for those services.
There are specific procedural outliers worth noting for utilization pattern reviews: code 65855 (laser trabeculoplasty) appears as an "extreme outlier, far above typical national volume" with 328 claims and $34.4K revenue (1.0% of Medicare revenue) despite being a smaller revenue contributor than cataract codes. Conversely, several higher‑complexity retinal codes (for example 66183 and 67113) are present at low percentiles (5th) and labeled "typical, unremarkable volume for this code," which suggests selective concentration on certain glaucoma and cataract interventions rather than broad high-volume retinal services.
Service breadth extends beyond straightforward cataract work: the Medicare top-25 list includes posterior-segment and corneal procedures such as 67042 (vitrectomy with membrane peel, $156.7K), 67036 (pars plana vitrectomy, $50.6K), 65756 (full-thickness corneal transplant, $35.5K), and V2785 (corneal tissue processing, $75.3K). The mix of anterior-segment cataract/lens codes, glaucoma interventions (e.g., 66991, 65855, 66174), and posterior-segment surgery indicates an ASC capable of both routine cataract cases and a subset of more complex intraocular and corneal procedures.
Payer mix and financial exposure should be framed by scale and concentration: total Medicare revenue reported is $3.5M compared with total Medicaid revenue of $238.2K, showing Medicare is the dominant payer by an order of magnitude. Given this split and the precomputed top‑3 concentration on Medicare (77.3%), changes in Medicare pricing or referral patterns for cataract and related codes would have an outsized impact on overall revenue.
The provider has established tenure in the Medicare/Medicaid environment, with an NPI enumerated on 2006-09-08 (≈20 years ago). That longevity, combined with high national percentiles for key cataract and glaucoma procedure codes, suggests a stable, mature ambulatory surgical operation with entrenched referral and procedural volume for its core ophthalmic services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
22 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 66984 | The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to… | 2,390 | $920 | $2.2M |
| 66991 | The provider inserts an intraocular lens prosthesis during the same session as extracapsular cataract extraction. The provider also inserts one or more anterior segment aqueous drainage devices in… | 120 | $2,790 | $340.9K |
| 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… | 90 | $1,690 | $156.7K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 680 | $220 | $147.1K |
| 66982 | The provider inserts an intraocular lens prosthesis after extracapsular cataract extraction using complex techniques and devices. He may perform this by means of an iris expansion device, providing… | 120 | $900 | $103.6K |
| 65820 | The provider incises the limbus to improve drainage of aqueous humor in the eye. This procedure is typically performed on children, usually to treat congenital glaucoma. | 50 | $1,510 | $78.4K |
| V2785 | Processing, preserving and transporting corneal tissue | 20 | $3,770 | $75.3K |
| 15823 | In this procedure, the provider surgically trims excessive skin that weighs down the upper eyelid, typically to improve the cosmetic appearance of the face and due to the interference of the tissue… | 130 | $560 | $71.4K |
| 67036 | The provider removes vitreous fluid from the eye to access the posterior segment of the eye and introduce surgical instruments through incisions in the pars plana. | 30 | $1,690 | $50.6K |
| 65756 | During this procedure, the provider performs a complete corneal transplant to replace a damaged corneal endothelium. | 20 | $1,690 | $35.5K |
Showing 1–10 of 22
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 22 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
22 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 66984 | 25 | 330 | 170 | $200 | $143.2K |
| V2785 | 2 | 10 | 20 | $3,630 | $101.6K |
| 66991 | 3 | 50 | 30 | $1,640 | $70.7K |
| 65820 | 7 | 30 | 30 | $1,050 | $37.9K |
| 66982 | 14 | 140 | 30 | $680 | $36.9K |
| 66174 | 6 | 10 | 20 | $910 | $30K |
| 66183 | 5 | 10 | 20 | $1,500 | $28.5K |
| 67904 | 5 | 20 | 40 | $650 | $27.3K |
| 67042 | 1 | 30 | 20 | $1,170 | $25.7K |
| 65756 | 4 | 10 | 20 | $1,220 | $25.5K |
Showing 1–10 of 22
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.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 66984 | The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to… | 860 | $280 | $237.6K |
| G8907 | Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer… | 1,610 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Massachusetts providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Massachusetts median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 66984 | The provider inserts an artificial lens after removing an extracapsular cataract by aspiration or use of ultrasonic waves. This procedure is done without the use of an endoscopic laser probe to… | 21 | 60 | 330 | $380 | $352.9K |
| G8907 | Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer… | 7 | 40 | 350 | $1 | $560 |
Other providers in the same ZIP code as Cape Cod Eye Surgery & Laser Center, LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| New England Home Medical Equipment, LLC | MA | Durable Medical Equipment & Medical Supplies | $0 | $56.2M |
| Cape Medical Supply LLC | MA | Durable Medical Equipment & Medical Supplies | $0 | $15.7M |
| Urgi Center Medical Group | MA | Urgent Care Clinic/Center | $0 | $5.8M |
| Cape Cod Pet/ct Services LLC | MA | Mobile Radiology Clinic/Center | $2.1M | $445.1K |
| Cape Cod Asc LLC | MA | Ambulatory Surgical Clinic/Center | $1.4M | $25.6K |
| Town Of Sandwich | MA | Ambulance | $623.9K | $636.6K |
| Michael Oats | MA | Ophthalmology Physician | $933.3K | $0 |
| Ramon Espinosa | MA | Internal Medicine Physician | $368.2K | $0 |
| Jessica Provo | MA | Family Medicine Physician | $333.8K | $0 |
| Susan Shanley | MA | Physical Therapist | $143.8K | $0 |
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