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NPI 1114091501 · West Springfield, MA · Ophthalmology Physician
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Cataract & Laser Center West, LLC is a ophthalmology physician provider located in West Springfield, Massachusetts. This profile covers 16 Medicare and 5 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 | Cataract & Laser Center West, LLC |
| Address | 171 Interstate Dr |
| City | West Springfield |
| State | MA |
| ZIP | 01089 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | November 20, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.4M |
| Medicaid | $3.2M |
Surgical cataract care is the core business line for this practice across both payers: Medicare revenue is driven by 66984 (2.7K claims, $2.2M revenue) and related intraocular lens insertion codes 66991 and 66982, while Medicaid billing is overwhelmingly concentrated in cataract extraction with 66984 (8K claims, $2.8M revenue) and 66982 (999 claims, $356.6K revenue). The mix of high-volume cataract extraction and lens implantation codes indicates an operation structured around high-throughput ambulatory ophthalmic surgery rather than primarily clinic-based medical management.
Revenue concentration is acute and payer-specific: the top three Medicare codes account for 83.5% of this provider's total Medicare revenue, showing Medicare income is concentrated in a small set of surgical procedures, while the top three Medicaid codes account for 100.0% of Medicaid revenue, indicating Medicaid receipts are essentially all tied to a very narrow set of surgical services. These precomputed shares signal a high dependency on a few procedure lines for commercial sustainability and payer negotiations.
The provider’s payer mix is nearly balanced in scale: total Medicare revenue is $3.4M and total Medicaid revenue is $3.2M, so the practice is not effectively single-payer and derives substantial volume from both programs. That parity suggests contracting and utilization strategies should be evaluated separately for each program given the different dominant codes and market positions.
National competitive standing for Medicare-coded cataract and glaucoma procedures is strong: 66984 ranks #625 of 15965 providers nationally (96th percentile; notably above typical national volume), 66991 ranks #25 of 1445 (98th percentile; notably above typical national volume), and 66982 ranks #34 of 4580 (99th percentile; notably above typical national volume). Additionally, code 65855 (249 claims, $24.7K revenue) is listed as an "extreme outlier" at the 99th percentile, reinforcing that this provider performs substantially more laser trabeculoplasty than most peers.
In-state competitive positioning on Medicaid is dominant for routine cataract surgery: 66984 is ranked #1 of 63 providers in-state (100th percentile; extreme outlier, far above typical state volume), and 66982 is #2 of 9 providers in-state (88th percentile). This combination implies the practice captures a large share of Medicaid-funded cataract surgical volume in Massachusetts and would be a major local competitor for network participation and care access.
The provider shows an established tenure: NPI enumerated 2006-11-20 (~20 years ago), indicating long-term operation in the market. That level of longevity paired with concentrated surgical revenue supports the interpretation of a mature surgical ophthalmology practice with stable referral and procedural workflows.
Procedure mix also signals an active glaucoma surgical program in addition to cataract services: codes for aqueous drainage device insertion (0449T — 29 claims, $65.4K revenue; 66989 — 26 claims, $64.4K revenue) plus MIGS/implant code 66183 (14 claims, $30.7K revenue) and high-volume laser procedures such as 65855 and 66821 (370 claims, $71K revenue) show the practice performs both device-based glaucoma interventions and postoperative laser care. These offerings diversify the surgical portfolio beyond routine cataract extraction and likely support higher-complexity case referrals.
Corneal services are present but represent a smaller revenue stream: V2785 (20 claims, $76.4K revenue) and 65756 (21 claims, $31.3K revenue) appear on the Medicare list, signaling capabilities in corneal tissue processing and full-thickness/partial corneal transplant procedures, though these codes account for a relatively small share of total revenue. This suggests corneal surgery is a supplementary line rather than a primary driver of the practice’s payer revenues.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
16 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… | 2,680 | $820 | $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… | 140 | $2,450 | $335K |
| 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… | 340 | $820 | $282.8K |
| V2785 | Processing, preserving and transporting corneal tissue | 20 | $3,820 | $76.4K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 370 | $190 | $71K |
| 0449T | The provider inserts the first aqueous drainage device into the interior of the eye with its end in the subconjunctival space; the device does not include a reservoir to hold the fluid. The device… | 30 | $2,260 | $65.4K |
| 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. | 60 | $1,060 | $64.8K |
| 66989 | The provider inserts an intraocular lens prosthesis during the same session as extracapsular cataract extraction using complex techniques and devices. The provider also inserts one or more anterior… | 30 | $2,480 | $64.4K |
| 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… | 40 | $1,480 | $53.3K |
| 65756 | During this procedure, the provider performs a complete corneal transplant to replace a damaged corneal endothelium. | 20 | $1,490 | $31.3K |
Showing 1–10 of 16
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 16 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
16 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 66984 | 22 | 330 | 170 | $200 | $143.2K |
| V2785 | 2 | 10 | 20 | $3,630 | $101.6K |
| 66991 | 2 | 50 | 30 | $1,640 | $70.7K |
| 66989 | 2 | 10 | 30 | $1,710 | $51.2K |
| 65820 | 4 | 30 | 30 | $1,050 | $37.9K |
| 66982 | 3 | 140 | 30 | $680 | $36.9K |
| 0449T | 1 | 10 | 20 | $1,550 | $32.5K |
| 66183 | 4 | 10 | 20 | $1,500 | $28.5K |
| 67042 | 2 | 30 | 20 | $1,170 | $25.7K |
| 65756 | 4 | 10 | 20 | $1,220 | $25.5K |
Showing 1–10 of 16
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.
5 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… | 7,990 | $350 | $2.8M |
| 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… | 1,000 | $360 | $356.6K |
| J1096 | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg | 30 | $90 | $2.3K |
| 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… | 780 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 780 | $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
5 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… | 1 | 60 | 330 | $380 | $352.9K |
| 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… | 2 | 10 | 110 | $430 | $152.3K |
| J1096 | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg | 1 | 10 | 30 | $90 | $2.3K |
| 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… | 13 | 40 | 350 | $1 | $560 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 9 | 20 | 390 | $1 | $160 |
Other providers in the same ZIP code as Cataract & Laser Center West, LLC, ranked by combined Medicare and Medicaid revenue.
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