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NPI 1144219379 · San German, PR · Ophthalmology Physician
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David Silva Caraballo is a ophthalmology physician provider located in San German, Puerto Rico. This profile covers 5 Medicare and 20 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 | Individual |
| Organization | David Silva Caraballo |
| Address | Luna Street Ave. Casto Perez |
| City | San German |
| State | PR |
| ZIP | 00683 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | October 20, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $4M |
| Medicare | $6.8K |
This provider is effectively Medicaid-focused: reported Medicaid revenue is $4M while Medicare revenue is $6.8K, so the majority of billings and earned revenue appear to come from Medicaid patients rather than Medicare. The Medicaid footprint dominates the financial profile and suggests operational emphasis on payer contracts and workflows tied to state Medicaid reimbursement.
Medicaid revenue is concentrated in a small set of high-volume procedures: the top three Medicaid codes (66984, 92012, 92273) account for 65.0% of the provider's Medicaid revenue, with 66984 ($1.1M, 1.7K claims) and 92012 ($1M, 17.9K claims) the largest single-code contributors. These top codes point to cataract surgery as a major revenue driver plus high volumes of follow-up/office-based eye exams and electrophysiologic testing supporting surgical care.
Medicare revenue is highly concentrated in diagnostic and office-evaluation codes: the top three Medicare codes (92012, 92273, 92250) make up 89.1% of Medicare revenue, dominated by 92012 ($3.1K, 50 claims) and 92273 ($2.3K, 27 claims). Medicare billing on file is small in scale and focused on intermediate exams and retinal electrophysiology rather than surgical billing, indicating the provider’s Medicare-facing activity is primarily outpatient diagnostic and follow-up care.
The specific code mix indicates a surgical ophthalmology practice with accompanying pre-op and diagnostic services: high Medicaid volume for 66984 (cataract extraction with IOL) paired with substantial claims for A-scan measurements (76519, 1.8K claims) and fundus photography (92250, 9.7K claims) supports a workflow that spans preoperative assessment, surgery, and post-op imaging. Multiple state-high ranks for surgical and pre/post-op codes imply integrated surgical throughput rather than isolated office-only care.
Competitively in-state the provider is a major participant: several Medicaid codes are ranked in the uppermost percentiles (examples: 92012 at the 99th percentile and described as an "extreme outlier, far above typical state volume," 92273 at the 100th percentile and described as "notably above typical state volume," and 92002 at the 99th percentile). These high rankings across evaluation, testing, and procedural codes indicate the provider is among the high-volume ophthalmology practices in Puerto Rico for those services.
By contrast, the provider is a modest participant nationally on Medicare-coded services: key Medicare codes show low-to-median national percentiles (92012 at the 36th percentile, 92273 at the 32nd percentile, 92250 at the 25th percentile and 92083 at the 3rd percentile), suggesting limited national-scale Medicare presence and routine, unremarkable national volumes for the typical Medicare ophthalmology codes billed.
Multiple Medicaid codes are flagged as statistical outliers in-state, indicative of concentrated operational emphasis rather than sporadic use: 92012 (17.9K claims) and 92015 (11.9K claims) are described as "extreme outlier, far above typical state volume," 92273 (4.7K claims) ranks #1 of 6 providers and is described as "notably above typical state volume," and 99024 (4.4K claims) is a 100th percentile extreme outlier. These unusually high claim counts for routine exam and global-period follow-up codes point to high throughput and standardized perioperative workflows driving volume.
The provider has long-tenure enrollment (NPI enumerated 2005-10-20, ~21 years ago), which combined with concentrated Medicaid surgical and diagnostic volume suggests an established practice and sustained service-line presence in the state. Longevity plus the observed code mix supports an interpretation of stable surgical capacity and persistent referral or internal patient flow for cataract and associated ophthalmic care.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 92012 | For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any… | 50 | $60 | $3.1K |
| 92273 | The provider performs an electrophysiologic test of retinal function, which may be referred to as conventional, full–field or Ganzfeld (ffERG) or flash/focal (fERG) electroretinography to assess… | 30 | $90 | $2.3K |
| 92250 | Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,… | 30 | $30 | $680 |
| 92083 | The provider may use one or more methods to determine the extent of a patient's visual field of one or both eyes; he interprets the results and prepares a report. Report this code for an extended… | 10 | $40 | $490 |
| 92020 | The provider examines the angle of the anterior chamber of the eye (the angle where the iris and cornea meet) using a special lens (goniolens) and slit–lamp or operating microscope to diagnose and… | 10 | $20 | $250 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 CPT/HCPCS codes.
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.
20 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… | 1,670 | $670 | $1.1M |
| 92012 | For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any… | 17,870 | $60 | $1M |
| 92273 | The provider performs an electrophysiologic test of retinal function, which may be referred to as conventional, full–field or Ganzfeld (ffERG) or flash/focal (fERG) electroretinography to assess… | 4,700 | $100 | $474.9K |
| 92002 | The provider performs an intermediate level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program. | 7,110 | $50 | $376.6K |
| 92015 | The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced. | 11,930 | $30 | $298.1K |
| 92250 | Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,… | 9,710 | $30 | $262.1K |
| 92083 | The provider may use one or more methods to determine the extent of a patient's visual field of one or both eyes; he interprets the results and prepares a report. Report this code for an extended… | 2,840 | $40 | $121.9K |
| 76519 | The provider uses A scan ultrasound echography to measure the axial length of the eye and determine the intraocular lens, or IOL calculation prior to cataract surgery. | 1,770 | $60 | $109.9K |
| 92225 | N/A | 2,350 | $20 | $56.5K |
| 65855 | In this procedure, the provider uses a laser to burn the trabecular meshwork, the tissue of mesh where the iris meets the sclera, to drain aqueous humor from the anterior chamber and treat glaucoma. | 150 | $290 | $45.1K |
Showing 1–10 of 20
How this provider's Medicaid billing volume and revenue compare to other Puerto Rico providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Puerto Rico median
20 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… | 8 | 60 | 160 | $380 | $270.5K |
| 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… | 7 | 10 | 110 | $510 | $153.3K |
| 92012 | For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any… | 5 | 350 | 540 | $50 | $96.4K |
| 92273 | The provider performs an electrophysiologic test of retinal function, which may be referred to as conventional, full–field or Ganzfeld (ffERG) or flash/focal (fERG) electroretinography to assess… | 1 | 10 | 210 | $90 | $87.8K |
| 92002 | The provider performs an intermediate level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program. | 5 | 440 | 370 | $40 | $38.5K |
| 92015 | The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced. | 4 | 530 | 630 | $20 | $32K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 97 | 200 | 120 | $80 | $30.5K |
| 92250 | Code 92250 describes the taking of fundus photographs, that is, photographs of the posterior segment of the inner aspect of the eye, to document alterations in the optic nerve head, retinal vessels,… | 3 | 160 | 420 | $20 | $26.4K |
| 76519 | The provider uses A scan ultrasound echography to measure the axial length of the eye and determine the intraocular lens, or IOL calculation prior to cataract surgery. | 1 | 20 | 170 | $70 | $22.8K |
| 92202 | The provider performs an extended ophthalmoscopy, typically with an indirect ophthalmoscope which utilizes a bright light and a hand–held indirect lens rather than the common hand–held one–piece… | 47 | 90 | 450 | $10 | $17.8K |
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Other providers in the same ZIP code as David Silva Caraballo, ranked by combined Medicare and Medicaid revenue.
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