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NPI 1053336602 · Richmond, VA · Ambulatory Surgical Clinic/Center
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Virginia Eye Institute Inc is a ambulatory surgical clinic/center provider located in Richmond, Virginia. This profile covers 35 Medicare and 12 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 | Virginia Eye Institute Inc |
| Address | 402 Westhampton Sta |
| City | Richmond |
| State | VA |
| ZIP | 23226 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | July 13, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.8M |
| Medicaid | $696.2K |
Business/service-line profile: The provider’s Medicare and Medicaid billings are dominated by ophthalmic surgical procedures, with a heavy emphasis on cataract surgery and related intraocular lens work (notably 66984 and 66982) and several glaucoma and retina procedures in the mix. High-paid supplies and tissue processing also appear in the Medicare mix (V2785), consistent with an ambulatory surgical clinic that manages both routine cataract throughput and more complex anterior/posterior segment cases.
Medicare revenue concentration: Top surgical and ophthalmic therapy codes are heavily concentrated — the top 3 Medicare codes by revenue account for 71.7% of this provider's total Medicare revenue. In particular, 66984 generates $2.6M (55.7% of Medicare revenue), 65820 generates $467.5K (9.9%), and J1096 generates $289.9K (6.1%), signaling that a small set of procedures drives the majority of Medicare dollars for this clinic.
Medicaid revenue concentration: Medicaid is even more concentrated in a narrow set of ophthalmic procedures — the top 3 Medicaid codes by revenue account for 94.4% of this provider's total Medicaid revenue. The Medicaid portfolio is dominated by 66984 at $527.3K (75.8%), followed by 66982 at $73.9K (10.6%) and 67228 at $55.1K (7.9%), indicating that cataract and retinal laser treatment comprise the vast majority of Medicaid activity.
Payer mix and scale: The provider reports materially greater Medicare revenue ($4.8M) than Medicaid revenue ($696.2K), so while it serves both payers it is substantially Medicare-weighted in scale. Both payers appear active in surgical ophthalmology, but Medicare is the primary revenue source supporting the clinic’s throughput and higher-cost services.
National competitive standing (Medicare): For several high-revenue Medicare codes the practice ranks well above typical national volumes — 66984 ranks #383 of 15965 (98th percentile; notably above typical national volume) and 66982 ranks #36 of 4580 (99th percentile). The pediatric glaucoma procedure 65820 is an extreme outlier nationally (rank #2 of 1249, 100th percentile), which suggests an unusually large concentration of that specific surgical case type relative to peers.
State competitive standing (Medicaid): In-state comparisons show leading positions on several Medicaid codes: 66982 ranks #1 of 4 providers in-state (100th percentile) and 67228 ranks #1 of 2 providers in-state (100th percentile), while 66984 ranks #8 of 50 (86th percentile). These rankings indicate the clinic is a prominent provider of certain cataract and retinal services within Virginia Medicaid, though 66984 is more typical in-state than it is nationally.
Statistical outliers and billing pattern flags: Multiple codes are flagged as unusually high relative to peers — 65820 on Medicare is described as an "extreme outlier, far above typical national volume" and several cataract/laser codes are "notably above typical" national volumes. On the Medicaid side there are large claim counts with $0 paid for G8918 (1.5K claims, $0 paid, ranks #1 of 16 in-state, labeled extreme outlier) and G8907 (1.4K claims, $0 paid, ranks #2 of 28 in-state), which may reflect reporting, encounter-only submissions, or payer-specific payment rules rather than clinical revenue.
Tenure and continuity: The NPI was enumerated on 2006-07-13 (~20 years ago), indicating long-standing presence in the market. Combined with concentrated high volumes in core ophthalmic procedures, the data are consistent with an established ambulatory surgical clinic with sustained surgical throughput over time.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
35 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… | 3,330 | $790 | $2.6M |
| 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. | 320 | $1,470 | $467.5K |
| J1096 | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg | 2,930 | $100 | $289.9K |
| 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… | 320 | $780 | $249.5K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 1,080 | $200 | $213.4K |
| V2785 | Processing, preserving and transporting corneal tissue | 40 | $3,750 | $157.5K |
| 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… | 230 | $500 | $115.2K |
| 67904 | The provider repairs a drooping eyelid by tightening the levator muscle that controls eyelid movement to improve cosmetic appearance or remove the obstruction to a patient’s vision. He accesses the… | 190 | $510 | $95.6K |
| 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… | 50 | $1,480 | $69.6K |
| 66174 | The provider expands the aqueous outflow (drainage) canal of the eye to help relieve pressure in the eye. The procedure does not include leaving a device or stent in place. | 40 | $1,490 | $59.5K |
Showing 1–10 of 35
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 35 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
35 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J1096 | 4 | 10 | 1,630 | $100 | $256.8K |
| V2785 | 3 | 10 | 40 | $3,750 | $146.1K |
| 66984 | 37 | 380 | 250 | $130 | $139K |
| 65820 | 1 | 40 | 30 | $1,110 | $63.1K |
| 15823 | 1 | 30 | 50 | $530 | $34.5K |
| 67042 | 5 | 20 | 20 | $1,130 | $33.8K |
| 66174 | 7 | 20 | 40 | $890 | $33.7K |
| 67904 | 1 | 20 | 50 | $580 | $32.8K |
| 65756 | 6 | 20 | 20 | $1,090 | $29.5K |
| 67966 | 3 | 10 | 50 | $490 | $28.9K |
Showing 1–10 of 35
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.
12 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… | 2,080 | $250 | $527.3K |
| 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… | 280 | $260 | $73.9K |
| 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… | 210 | $270 | $55.1K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 30 | $640 | $21.3K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 20 | $660 | $12.5K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 30 | $110 | $3.1K |
| V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | 30 | $70 | $2K |
| V2020 | Frames, purchases | 30 | $10 | $410 |
| 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… | 1,380 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 1,520 | $0 | $0 |
Showing 1–10 of 12
How this provider's Medicaid billing volume and revenue compare to other Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Virginia median
12 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 25 | 30 | 50 | $1,670 | $401.7K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 34 | 50 | 110 | $840 | $309.8K |
| 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… | 8 | 50 | 200 | $350 | $282.9K |
| 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… | 1 | 10 | 100 | $420 | $56.4K |
| V2020 | Frames, purchases | 326 | 400 | 230 | $40 | $36.6K |
| 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… | 1 | 10 | 110 | $280 | $31.4K |
| V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | 287 | 350 | 160 | $30 | $19K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 4 | 10 | 110 | $100 | $12.8K |
| V2760 | Scratch resistant coating, per lens | 40 | 50 | 40 | $10 | $2.2K |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 1 | 20 | 70 | $1 | $20 |
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Other providers in the same ZIP code as Virginia Eye Institute Inc, ranked by combined Medicare and Medicaid revenue.
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