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NPI 1194970418 · Albuquerque, NM · Ambulatory Surgical Clinic/Center
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Pacific Cataract And Laser Institute Inc PC is a ambulatory surgical clinic/center provider located in Albuquerque, New Mexico. This profile covers 5 Medicare and 3 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 | Pacific Cataract And Laser Institute Inc PC |
| Address | 8220 San Pedro Ne |
| City | Albuquerque |
| State | NM |
| ZIP | 87113 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | December 1, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $647.5K |
| Medicaid | $64.6K |
This entity is structured as an Ambulatory Surgical Clinic/Center and its billed procedures are overwhelmingly consistent with a cataract-focused surgical practice: the Medicare and Medicaid top codes center on cataract extraction and intraocular lens placement (notably 66984) with ancillary procedures like posterior capsulotomy (66821) and combined IOL plus anterior segment device placement (66991) appearing at lower volumes. The predominance of these codes indicates an operation set up for high-throughput elective ophthalmic surgery rather than broad multispecialty outpatient care.
Revenue concentration on Medicare is extreme: the precomputed top-3 Medicare codes account for 97.2% of this provider’s total Medicare revenue, with 66984 alone reporting $523.1K (80.8% of Medicare revenue), 66991 $82.9K (12.8%), and 66821 $23.4K (3.6%). This concentration signals that the financial health of the Medicare book is highly dependent on routine cataract procedures coded as 66984 and a small number of higher-reimbursement complex cases coded as 66991.
Medicaid billing is effectively mono-line: the precomputed top-3 Medicaid codes account for 100.0% of the provider’s Medicaid revenue and 66984 represents $63.2K (97.6% of Medicaid revenue), while the next two Medicaid codes (92136 and 00142) contribute only nominal sums. That pattern suggests the provider performs very little non-surgical or ancillary Medicaid-paid ophthalmology work and relies on standard cataract surgery for nearly all Medicaid receipts.
The payer mix is heavily Medicare-weighted: reported Medicare revenue is $647.5K versus Medicaid revenue of $64.6K, so Medicare is the dominant revenue source. Analysts should expect payer-contracting leverage, utilization drivers, and revenue risk to be concentrated in Medicare-facing surgical volumes rather than Medicaid.
Competitive standing on key Medicare codes is solid but not dominant: 66984 ranks #2511 of 15965 nationally (84th percentile) and is described as a “typical, unremarkable volume” at that percentile, while 66821 also sits at the 84th percentile and 66991 is at the 57th percentile. These placements imply the provider operates above median national volume for routine cataract work but is not among the highest-volume, nationally dominant centers.
In the in-state Medicaid market the provider is mid-pack: 66984 ranks #15 of 26 providers in-state (44th percentile) and is characterized as a typical volume for that code. Given the limited number of Medicaid-performing peers and the provider’s concentrated Medicaid mix, the practice likely competes for a modest share of state Medicaid cataract cases rather than serving as a statewide leader.
Tenure and stability are evident: the NPI was enumerated on 2008-12-01 (~18 years ago), indicating a long-standing presence in the market. Combined with the focused, surgery-oriented code mix, this suggests an established ambulatory cataract surgery operation rather than a newly formed facility.
Payment and service-level differentials are notable: 66984 shows an average Medicare paid/claim of $816 versus a Medicaid average paid/claim of $347, reflecting a large payer payment gap for the same core procedure. Less-revenue Medicare codes such as 66982 and 65855 together contribute only small shares of Medicare revenue and sit at relatively low national percentiles, indicating occasional complex or glaucoma-related interventions but not a consistent secondary service line.
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 |
|---|---|---|---|---|
| 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… | 640 | $820 | $523.1K |
| 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… | 30 | $2,440 | $82.9K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 140 | $170 | $23.4K |
| 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… | 20 | $820 | $16.4K |
| 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. | 20 | $90 | $1.8K |
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.
3 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… | 180 | $350 | $63.2K |
| 92136 | The provider uses a noninvasive method to measure the patient’s eye or eyes to get information that the provider then uses to calculate the appropriate power for an intraocular lens (IOL). Selecting… | 80 | $10 | $780 |
| 00142 | The provider performs anesthesia services for a patient undergoing an eye lens procedure. | 20 | $30 | $740 |
How this provider's Medicaid billing volume and revenue compare to other New Mexico providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New Mexico median
3 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… | 15 | 30 | 280 | $400 | $607.8K |
| 00142 | The provider performs anesthesia services for a patient undergoing an eye lens procedure. | 8 | 10 | 570 | $60 | $93K |
| 92136 | The provider uses a noninvasive method to measure the patient’s eye or eyes to get information that the provider then uses to calculate the appropriate power for an intraocular lens (IOL). Selecting… | 7 | 10 | 330 | $30 | $67.7K |
Other providers in the same ZIP code as Pacific Cataract And Laser Institute Inc PC, ranked by combined Medicare and Medicaid revenue.
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