Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or West Virginia for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to West Virginia only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. West Virginia (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Heath Lemley (NPI 1215000369)

Field	Value
Entity Type	Individual
Organization	Heath Lemley
Address	1255 Pineview Dr
City	Morgantown
State	WV
ZIP	26505
Taxonomy	Ophthalmology Physician
NPI Enumerated	November 16, 2006

Payer Source	Total Paid
Medicare	$512.8K
Medicaid	$0

Key Findings

HEATH LEMLEY’s billing footprint is effectively single‑payer Medicare: lifetime Medicare revenue is $512.8K and there is no Medicaid billing on file. The absence of Medicaid activity suggests the provider’s outpatient volume and revenue are concentrated in the Medicare population rather than split across dual public payers.

Revenue concentration is high: the precomputed top three Medicare codes account for 60.1% of the provider’s total Medicare revenue, driven by 66984 at $168.1K (32.7%), 99213 at $83.4K (16.3%), and 92014 at $57.2K (11.1%). This three‑code concentration indicates a narrow set of procedures and encounters account for the majority of billed Medicare dollars.

The procedure mix signals a cataract-centric ophthalmology practice. 66984 (417 claims, $168.1K revenue, 32.7%) is the single largest revenue source, and related procedures appear in the top codes: 66821 (149 claims, $44.1K, 8.6%) and 66982 (55 claims, $30.8K, 6.0%) together show both routine and more complex cataract surgery activity with follow‑up laser capsulotomy services. These surgical codes, combined with biometry and imaging codes, are consistent with an operation that performs cataract surgery and manages perioperative follow‑up in‑office.

Clinic visit volume is unusually high relative to national peers. 99213 shows 1.4K claims and $83.4K revenue (16.3%) and is flagged as an "extreme outlier" (99th percentile), and 99204 (208 claims, $22.7K, 4.4%) is also an "extreme outlier" (98th percentile). Those volumes indicate heavy ambulatory throughput and substantial new‑patient and return‑visit clinic activity supporting the surgical practice.

Diagnostic and imaging intensity is elevated: 92133 has 596 claims and $14.9K revenue (2.9%) and is marked an "extreme outlier" (98th percentile), while 92136 (458 claims, $13.3K, 2.6%) and 92134 (411 claims, $11.5K, 2.2%) are above typical peer volumes. The high counts for OCT and biometry codes signal in‑office imaging capacity that likely supports both cataract planning and retina/optic nerve assessment.

Competitive standing is mixed by service line: for the primary surgical code 66984 the provider ranks #3277 of 15965 (79th percentile) — a solid but not dominant national surgical volume — whereas the office E/M and OCT imaging codes place the provider among national high‑volume outliers (e.g., 99213 at the 99th percentile and 92133 at the 98th percentile). In sum, the practice is not a leading national cataract surgery center but is unusually high‑volume for clinic visits and diagnostic imaging.

Smaller procedure streams contribute modestly to revenue and indicate scope of ancillary services: codes such as 68761 (31 claims, $4.1K, 0.8%) and 65855 (13 claims, $2.3K, 0.5%) represent lower‑volume lacrimal and glaucoma laser services and are characterized as typical/unremarkable volumes. These smaller items suggest the practice offers some minor oculoplastic and glaucoma procedures, but they are not major revenue drivers.

Tenure and market position: the provider’s NPI was enumerated 2006-11-16 (~20 years ago), indicating an established presence in the Morgantown, WV market. That longevity plus the heavy Medicare and clinic/imaging volumes is consistent with a mature solo or small‑group ophthalmology practice focused on cataract surgery and high outpatient throughput rather than broad Medicaid participation.

Medicare: Complete Services Breakdown

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

21 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…	420	$400	$168.1K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	1,370	$60	$83.4K
92014	An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group…	640	$90	$57.2K
66821	The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract.	150	$300	$44.1K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	420	$90	$36.3K
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…	60	$560	$30.8K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	210	$110	$22.7K
92133	The provider performs computerized diagnostic imaging of the optic nerve in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both…	600	$30	$14.9K
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…	460	$30	$13.3K
92134	The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes.	410	$30	$11.5K

Showing 1–10 of 21

Medicare: Competitive Analysis & Benchmarks

How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 21 CPT/HCPCS codes.

View: State1 / 2

Claims Volume vs. West Virginia Distribution

Heath Lemley — 5 of 21 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. state median

21 rows

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
66984	39	90	210	$70	$60.7K
66982	9	30	30	$400	$17.9K
92014	17	180	120	$70	$16.3K
66821	6	50	50	$190	$16.2K
99214	254	2,740	100	$70	$11.8K
99213	9	2,860	80	$50	$7.5K
92136	11	40	160	$20	$6.1K
65855	15	20	30	$160	$5.8K
92134	15	160	60	$30	$5.4K
92004	19	150	40	$80	$4.7K

Showing 1–10 of 21

Related Providers

Other providers that share a Tax Identification Number (TIN) with Heath Lemley, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Gary Miller	WV	Ophthalmology Physician	$6.3M	$0
Regional Eye Associates, Inc	WV	Ambulatory Surgical Clinic/Center	$1.5M	$67.7K
Stephen Powell	WV	Ophthalmology Physician	$525.5K	$0
Mark Mayle	WV	Ophthalmology Physician	$372.9K	$0
Brian Wood	WV	Ophthalmology Physician	$324.6K	$0
Edgar Gamponia	WV	Ophthalmology Physician	$256.6K	$0
Allison Bardes	WV	Ophthalmology Physician	$172.5K	$0
Lauren Digiovine	WV	Ophthalmology Physician	$164.2K	$0
Jennifer Talkington	WV	Certified Registered Nurse Anesthetist	$68.9K	$0
Stacy Commodore	WV	Certified Registered Nurse Anesthetist	$65.9K	$0

Nearby Providers

Other providers in the same ZIP code as Heath Lemley, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Interim Healthcare Of Pittsburgh, Inc.	WV	Nursing Care Agency	$0	$23.1M
Monongalia County General Hospital Company	WV	General Acute Care Hospital	$0	$16.3M
Monongalia Emergency Medical Services Inc	WV	Ambulance	$1.4M	$11.3M
Gr&w, Inc	WV	Clinical Neuropsychologist	$0	$12.2M
Cardinal Pediatrics PLLC	WV	Pediatrics Physician	$0	$11.1M
Pace Training And Evaluation Center, Inc	WV	Developmentally Disabled Services Day Training Agency	$0	$9.2M
Therapy Services, LLC	WV	Speech-Language Pathologist	$0	$8.5M
Monongalia County General Hospital Company	WV	Specialist	$0	$6.8M
West Virginia Emergency Physicians, LLP	WV	Emergency Medicine Physician	$0	$4.7M
Renaissance Care Inc	WV	In Home Supportive Care Agency	$0	$3.1M

Heath Lemley — Billing Profile & Reimbursement Data

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Key Findings

Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Related Providers

Nearby Providers

Frequently Asked Questions

References