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NPI 1205998648 · Morgantown, WV · Ambulatory Surgical Clinic/Center
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Regional Eye Associates, Inc is a ambulatory surgical clinic/center provider located in Morgantown, West Virginia. This profile covers 8 Medicare and 1 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 | Regional Eye Associates, Inc |
| Address | 1299 Pineview Dr |
| City | Morgantown |
| State | WV |
| ZIP | 26505 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | December 14, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.5M |
| Medicaid | $67.7K |
REGIONAL EYE ASSOCIATES, INC is listed as an Ambulatory Surgical Clinic/Center in MORGANTOWN, WV and its NPI was enumerated (registered) on 2006-12-14 (~20 years ago), indicating long-tenure operation in the market. The CPT mix and volumes point to a surgery-focused ophthalmology practice rather than a primary-care or broad multispecialty clinic. 66984, J1097 and related cataract/intraocular lens codes dominate billing on both payers.
Medicare revenue is concentrated: the top 3 Medicare codes account for 91.7% of this provider's total Medicare revenue, driven primarily by 66984 (61.1%) and J1097 (23.6%) out of $1.5M in lifetime Medicare revenue. That concentration signals that cataract procedures and associated ophthalmic supplies are the primary revenue drivers for Medicare business.
Medicaid billing is effectively single-procedure: the provider reports $67.7K in lifetime Medicaid revenue and the top Medicaid code 66984 represents 100.0% of that Medicaid revenue. In practical terms, Medicaid reimbursement for this clinic is almost entirely dependent on extracapsular cataract extraction with intraocular lens insertion.
Competitive standing by code is mixed but skewed toward strong cataract volume: 66984 ranks #1732 of 15965 nationally (89th percentile), which indicates relatively high but described-as-typical volume for that cataract code among Medicare peers. J1097 ranks #44 of 443 nationally (90th percentile), signaling an unusually high relative use of this ophthalmic irrigation product among its Medicare peer group, while 66991 sits at #371 of 1445 (74th percentile), a more modest but still above-median position.
Within the state Medicaid peer set, the clinic’s 66984 activity ranks #10 of 22 providers (57th percentile), placing it in the mid-range of in-state cataract providers rather than as a dominant Medicaid cataract center. This contrast—strong national percentile positions for some Medicare codes but middling in-state Medicaid rank—underscores a Medicare-centric competitive posture.
Service-line implications from the code mix: frequent billing for 66984 and J1097 aligns with high-volume cataract surgery workflows and routine use of intraoperative ophthalmic irrigation/medications. Presence of codes such as 66982 and 66991 (complex and combined intraocular procedures), 66821 (YAG capsulotomy), 67036 (pars plana vitrectomy) and 15823 (upper eyelid surgery) shows the clinic performs some complex anterior-segment cases and occasional posterior-segment or oculoplastic procedures, but these are secondary revenue contributors.
The payer mix is heavily Medicare-dominant: lifetime Medicare revenue of $1.5M far exceeds $67.7K in Medicaid revenue, so reimbursement exposure, volume swings, and policy changes affecting Medicare payments will materially affect overall clinic revenue more than Medicaid dynamics. Operational or strategic shifts that affect cataract throughput would therefore disproportionately impact the practice’s financial profile.
Concentration risk is notable: with the top 3 Medicare codes driving 91.7% of Medicare dollars and a single code (66984) making up 100.0% of Medicaid dollars, the practice has concentrated earnings tied to a narrow set of cataract-related services. That creates vulnerability to changes in coding, reimbursement for key supplies like J1097, or local competitive shifts in cataract service capacity.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
8 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… | 1,250 | $760 | $945.7K |
| J1097 | phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml | 4,810 | $80 | $365.5K |
| 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… | 50 | $2,290 | $107.8K |
| 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… | 70 | $770 | $52.1K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 230 | $160 | $35.7K |
| 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… | 40 | $470 | $19.4K |
| 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. | 10 | $1,320 | $17.2K |
| 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. | 60 | $70 | $3.8K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 8 CPT/HCPCS codes.
View: State1 / 2
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.
1 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… | 190 | $350 | $67.7K |
How this provider's Medicaid billing volume and revenue compare to other West Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. West Virginia median
1 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… | 10 | 20 | 100 | $180 | $81.5K |
Other providers in the same ZIP code as Regional Eye Associates, Inc, ranked by combined Medicare and Medicaid revenue.
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