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NPI 1225107014 · Lexington, KY · Ambulatory Surgical Clinic/Center
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Commonwealth Eye Clinic Inc is a ambulatory surgical clinic/center provider located in Lexington, Kentucky. This profile covers 5 Medicare and 4 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 | Commonwealth Eye Clinic Inc |
| Address | 2353 Alexandria Dr |
| City | Lexington |
| State | KY |
| ZIP | 40504 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | November 7, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.6M |
| Medicaid | $1M |
Clinical focus: The provider’s billing mix is concentrated in ophthalmic surgical procedures consistent with an ambulatory surgical clinic that specializes in cataract care and related eye surgeries — the ledger is dominated by cataract extraction and lens insertion (66984), posterior capsulotomy (66821), and complex lens procedures (66982). Smaller but present procedural lines include eyelid repair (67904) and trabeculoplasty for glaucoma (65855), which together suggest the clinic offers a range of outpatient ophthalmic surgical services beyond routine cataract cases.
Medicare revenue concentration: The top 3 Medicare codes by revenue account for 97.5% of this provider's total Medicare revenue, with 66984 alone representing $1.3M and 81.4% of Medicare revenue. This concentration indicates Medicare income is highly dependent on a narrow set of cataract-related procedures rather than a broad procedural mix.
Medicaid revenue concentration: The top 3 Medicaid codes by revenue account for 100.0% of this provider's total Medicaid revenue, and 66984 drives the vast majority of Medicaid dollars with $1M in revenue (97.2% of Medicaid revenue). Medicaid billings are therefore almost entirely composed of cataract surgery activity, reflecting a payer-specific concentration in a single service line.
Payer mix and scale: Lifetime Medicare revenue ($1.6M) exceeds lifetime Medicaid revenue ($1M) but both payers represent material streams for the clinic, so the practice is not effectively single-payer. The clinic operates as a mixed Medicare–Medicaid ambulatory surgical provider with a larger footprint in Medicare dollars while still relying on substantial Medicaid cataract volume.
National competitive standing on Medicare codes: The provider shows a mixed profile versus national peers — 66821 ranks #141 of 10087 providers nationally (99th percentile; notably above typical national volume), marking a clear above-peer strength in posterior capsulotomy procedures, while 66984 ranks #1316 of 15965 (92th percentile; typical, unremarkable volume) and 66982 ranks #161 of 4580 (96th percentile; typical, unremarkable volume), indicating solid but not dominant national presence for routine cataract extraction and complex intraocular lens work.
State competitive standing on Medicaid codes: On Medicaid, the provider is a high-volume state-level participant for cataract surgery — 66984 ranks #6 of 71 providers in-state (93th percentile; notably above typical state volume) and 66821 ranks #2 of 8 in-state (86th percentile; typical, unremarkable volume). These rankings point to a prominent role in Medicaid-funded cataract care within Kentucky.
Reimbursement profile by payer for the same service: The same high-volume surgical code 66984 shows materially different average payments by payer: Medicare average paid/claim is $798 while Medicaid average paid/claim is $290. This disparity highlights payer-dependent revenue per case for the clinic even where identical procedures dominate both books of business.
Administrative/quality coding pattern on Medicaid: Several Medicaid-listed codes such as G8918 (704 claims) and G8907 (789 claims) appear with large claim counts but $0 avg paid/claim and $0 revenue, suggesting these are encounter- or quality-reporting codes that generate administrative activity without direct reimbursement. Analysts should treat these lines as operational/quality documentation rather than revenue drivers.
Tenure and operational implication: The NPI was enumerated on 2006-11-07 (~20 years ago), indicating an established practice with long-term presence in the market. Combined with the concentrated cataract surgical volume, this tenure supports the interpretation of an experienced ambulatory surgical clinic with an entrenched cataract 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… | 1,670 | $800 | $1.3M |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 730 | $200 | $142.7K |
| 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… | 150 | $810 | $120.1K |
| 67904 | The provider repairs a drooping eyelid by tightening the levator muscle that controls eyelid movement to improve cosmetic appearance or remove the obstruction to a patient’s vision. He accesses the… | 40 | $980 | $38.1K |
| 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. | 30 | $90 | $2.4K |
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.
4 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… | 3,460 | $290 | $1M |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 300 | $90 | $28.5K |
| 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… | 790 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 700 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky median
4 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… | 6 | 70 | 210 | $310 | $290K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 2 | 10 | 150 | $90 | $15.4K |
| 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… | 7 | 20 | 260 | $1 | $1 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 4 | 10 | 180 | $1 | $1 |
Other providers in the same ZIP code as Commonwealth Eye Clinic Inc, ranked by combined Medicare and Medicaid revenue.
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