Maine Eye Center, PA — Billing Profile & Reimbursement Data

MAINE EYE CENTER, PA is an ambulatory surgical clinic in Portland, ME (taxonomy: Ambulatory Surgical Clinic/Center) with an NPI enumerated on 2007-03-29 (~19 years ago). The claims and code mix are concentrated in ophthalmic surgery, consistent with an eye surgery center rather than a broad multispecialty practice. Top revenue codes across both payers are procedure-based surgical CPTs rather than evaluation & management codes, indicating a primarily procedural, facility-based revenue model.

Medicare revenue scale and concentration: the provider reports Total Medicare revenue of $1.2M, with the precomputed top-3 Medicare codes accounting for 75.2% of that Medicare revenue. The Medicare billing is heavily weighted to 66984 (63.2% of this provider's total Medicare revenue), with smaller contributions from 65820 (8.5%) and 15823 (3.6%), signaling a reliance on a small set of high-revenue ophthalmic procedures.

Medicaid revenue and single-service concentration: Total Medicaid revenue is $578.7K, and the Medicaid top-3 codes account for 100.0% of Medicaid revenue. In practice this is dominated by one procedure, 66984 (1.7K claims, $335 avg paid/claim, $578.9K revenue, listed as 100.0% of Medicaid revenue), meaning Medicaid volume and revenue are effectively all tied to routine cataract extraction with intraocular lens placement.

Payer mix and scale comparison: Medicare ($1.2M) is the larger payer relationship compared with Medicaid ($578.7K) on lifetime revenue as reported, so Medicare is the primary revenue source while Medicaid remains a meaningful but smaller payer stream. Given the Medicaid activity is nearly all 66984, the practice’s Medicaid exposure is concentrated in the same cataract service line that dominates Medicare billing.

Competitive standing — Medicare: for the leading Medicare code 66984 the provider ranks #2028 of 15965 (87th percentile) and is described in the source as “typical, unremarkable volume for this code,” indicating an above‑median national presence on cataract surgery but not a national outlier or dominant center. Other Medicare codes such as 65820 (rank #110 of 1249, 91st percentile) show relatively strong national placement for that pediatric glaucoma procedure, while most additional codes are characterized in the dataset as typical volumes rather than exceptional.

Competitive standing — Medicaid/in‑state: for Medicaid 66984 the provider ranks #4 of 26 in-state (88th percentile), which positions the center as a top-tier in-state performer for Medicaid-paid cataract surgery. That rank, combined with Medicaid revenue being 100.0% tied to 66984, suggests the center is a leading Medicaid cataract provider in Maine even though its national Medicare cataract rank is more modest.

Service-line detail from the code mix: the billed CPTs point to a mix of routine cataract surgery (66984) plus retina/vitreous procedures (67042, 67040, 67041, 67113, 67108) and oculoplastic/eyelid work (15823, 67900). This pattern supports an ambulatory surgical center model that handles high-volume cataract cases plus a meaningful portfolio of posterior-segment and eyelid surgeries, implying staffing and equipment for both anterior and posterior ophthalmic surgery.

Statistical and non‑revenue reporting observations: most top CPTs are labeled in the source as “typical, unremarkable volume for this code,” and no Medicare code is flagged as an extreme outlier in this dataset. On the Medicaid side G8907 appears with 801 claims but $0 revenue (0.0% of Medicaid revenue) and is a documented non-revenue patient-safety/quality event code, indicating administrative reporting activity that does not drive revenue.