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NPI 1275513806 · Appleton, WI · Ambulatory Surgical Clinic/Center
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Pinnacle Cataract And Laser Institute LLC is a ambulatory surgical clinic/center provider located in Appleton, Wisconsin. 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 | Pinnacle Cataract And Laser Institute LLC |
| Address | 4648 W Spencer St |
| City | Appleton |
| State | WI |
| ZIP | 54914 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | January 19, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $994.5K |
| Medicaid | $481.6K |
PINNACLE CATARACT AND LASER INSTITUTE LLC presents as a high-volume cataract surgery-focused ambulatory surgical clinic: the cataract extraction code 66984 is the single largest revenue driver on both payers (Medicare: 822 claims generating $687.2K, 69.1% of the provider's Medicare revenue; Medicaid: 1.3K claims generating $481.6K, 100.0% of the provider's Medicaid revenue). The presence of codes for intraocular lens insertion (66991, 66982) and secondary capsulotomy (66821) further supports a practice model centered on surgical cataract care plus routine postoperative procedures.
Revenue concentration is pronounced: the provider’s top 3 Medicare codes account for 86.6% of Medicare revenue, and the top 3 Medicaid codes account for 100.0% of Medicaid revenue. This level of concentration indicates the organization’s financial performance is heavily dependent on a narrow set of ophthalmologic surgical services, particularly 66984.
Payer mix shows Medicare is the larger single-payer source by absolute dollars: total Medicare revenue is $994.5K versus total Medicaid revenue of $481.6K. Both payers are active, but Medicare supplies the larger share of lifetime revenue, making it the primary commercial exposure for this clinic.
National competitive standing on the flagship Medicare cataract code is above average but not dominant: for Medicare 66984 the provider ranks #2200 of 15965 (86th percentile; typical, unremarkable volume). The secondary Medicare cataract-related code 66991 ranks #340 of 1445 (75th percentile; typical, unremarkable volume), indicating meaningful but not exceptional national presence across leading cataract procedure codes.
State-level Medicaid positioning for the primary cataract code is strong: Medicaid 66984 ranks #4 of 33 in-state (91th percentile; typical, unremarkable volume). This ranking signals the provider is among the larger Medicaid cataract billers within Wisconsin, controlling a substantial share of in-state Medicaid cataract procedure volume despite the labeled characterization as typical.
Ancillary and post‑op care are visible but represent smaller revenue slices: Medicare billing for 66821 (157 claims, $31.7K, 3.2% of Medicare revenue) and medication/intraoperative supply codes such as J1097 (644 claims, $48.9K, 4.9% of Medicare revenue) and J1096 (220 claims, $21.6K, 2.2% of Medicare revenue) indicate routine provision of YAG capsulotomy and perioperative pharmaceuticals alongside surgery. These lines suggest the clinic captures downstream procedural and drug-related follow-up revenue rather than a broad mix of unrelated specialty services.
Some niche services appear at limited scale: the Medicare V2785 corneal tissue processing entry (14 claims, $50.8K, 5.1% of Medicare revenue) is present but ranks #197 of 231 (14th percentile; typical, unremarkable volume), indicating the provider bills for corneal tissue handling but at a low national standing. This suggests occasional involvement in corneal transplant support or related workflows without a leading national footprint.
The provider has long operational tenure which supports continuity in the observed billing pattern: NPI enumeration occurred on 2006-01-19 (~20 years ago). Extended tenure combined with concentrated cataract revenues implies an established specialty clinic with a stable, surgery-centered business model.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
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… | 820 | $840 | $687.2K |
| 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 | $2,520 | $123.2K |
| V2785 | Processing, preserving and transporting corneal tissue | 10 | $3,630 | $50.8K |
| J1097 | phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml | 640 | $80 | $48.9K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 160 | $200 | $31.7K |
| J1096 | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg | 220 | $100 | $21.6K |
| 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 | $840 | $17.6K |
| 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… | 30 | $490 | $13.8K |
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… | 1,270 | $380 | $481.6K |
How this provider's Medicaid billing volume and revenue compare to other Wisconsin providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Wisconsin 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… | 4 | 30 | 210 | $310 | $207.3K |
Other providers in the same ZIP code as Pinnacle Cataract And Laser Institute LLC, ranked by combined Medicare and Medicaid revenue.
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