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NPI 1376599381 · Portland, ME · Ambulatory Surgical Clinic/Center
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Eyecare Medical Group is a ambulatory surgical clinic/center provider located in Portland, Maine. This profile covers 20 Medicare and 5 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 | Eyecare Medical Group |
| Address | 53 Sewall Street |
| City | Portland |
| State | ME |
| ZIP | 04102 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | May 25, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.7M |
| Medicaid | $878.1K |
EYECARE MEDICAL GROUP presents as an ambulatory surgical clinic/center with a clear surgical ophthalmology focus: its top Medicare and Medicaid revenue drivers are cataract extraction and intraocular lens procedures (notably 66984, 66982 and 66991), and the presence of codes for intraocular drainage devices (0449T, 66991) and corneal tissue processing (V2785) indicates an ASC workflow that handles both routine cataract cases and some specialty ocular procedures. This code mix is consistent with a surgery-centric practice rather than a general ophthalmology clinic.
Revenue concentration on Medicare is highly concentrated in a small set of cataract-related codes: the precomputed top three Medicare codes account for 76.1% of this provider's total Medicare revenue, with 66984 alone representing $1.1M (67.0% of this provider's total Medicare revenue) of the $1.7M in Medicare receipts. Despite the large share, 66984 is described as a "typical, unremarkable volume for this code" nationally (rank #1661 of 15965, 90th percentile), which suggests high but not anomalous national participation in this common cataract procedure.
Medicaid billing is even more concentrated: the top three Medicaid codes account for 100.0% of Medicaid revenue, and Medicaid cataract activity is a dominant element of the provider’s state-level footprint. In Medicaid, 66984 accounts for $822.3K (93.6% of this provider's total Medicaid revenue) with 2.7K claims and ranks #2 of 26 in-state (96th percentile; "notably above typical state volume"), while 66821 contributes $49K (5.6% of this provider's total Medicaid revenue) and ranks #1 of 3 in-state (100th percentile; "typical, unremarkable volume for this code").
The payer mix shows Medicare as the larger revenue source but Medicaid is material: Medicare revenue is $1.7M versus $878.1K in Medicaid revenue, so the practice operates with a mixed payer base rather than as effectively single-payer. Both payers meaningfully support the ASC-sited cataract business line, with Medicare carrying a larger absolute share and Medicaid showing pronounced state-level concentration in the same procedure.
Competitive standing is mixed by geography and payer: nationally the provider posts a high but described-as-typical profile on the headline cataract code 66984 (90th percentile nationally), indicating substantial national-level volume without being an extreme outlier, while at the state Medicaid level the provider is a leading cataract performer (66984 rank #2 of 26, 96th percentile; "notably above typical state volume"). Conversely, certain Medicare services such as corneal tissue processing V2785 generate meaningful revenue contribution ($56.8K, 3.4% of Medicare revenue) yet rank lower against national peers (#197 of 231, 14th percentile; "typical, unremarkable volume for this code"), highlighting pockets of relative weakness or specialization differences versus national providers.
Operational and documentation patterns show unusually high counts for zero-paid quality/process codes in Medicaid: G8907 and G8918 each have 1.1K claims with $0 avg paid/claim and rank #1 in-state (100th percentile; "notably above typical state volume"). This pattern likely reflects systematic capture and submission of pre/postoperative safety documentation or state reporting practices rather than direct revenue drivers, and may be relevant for analytics that rely on claim counts as proxies for case volume or process adherence.
The practice performs a broader set of ophthalmic surgeries beyond cataract work, but at lower share levels: Medicare records vitrectomy and retina procedures such as 67041 ($32.3K, 1.9% of Medicare revenue) and 67036 ($26.1K, 1.5% of Medicare revenue), and oculoplastic codes like 15823 ($30.7K, 1.8% of Medicare revenue) and 67917 ($28.9K, 1.7% of Medicare revenue). These secondary code lines indicate capability for posterior-segment surgery and eyelid reconstructive work, but they do not materially dilute the provider’s primary cataract-driven revenue concentration.
The provider has been enumerated for a substantial period (NPI enumerated 2006-05-25, approximately 20 years ago), which supports an interpretation of established operational tenure; combined with the concentrated cataract volumes across both Medicare and Medicaid, this suggests a stable, surgery-focused ASC business model rather than a recent entrant or transient operation.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
20 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… | 1,320 | $860 | $1.1M |
| 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… | 100 | $860 | $82.6K |
| 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… | 30 | $2,560 | $71.6K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 360 | $180 | $63.9K |
| V2785 | Processing, preserving and transporting corneal tissue | 10 | $4,060 | $56.8K |
| 67041 | In this procedure, the provider removes scar tissue from the retinal membrane that obscures vision. He removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical… | 20 | $1,540 | $32.3K |
| 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… | 70 | $440 | $30.7K |
| 0449T | The provider inserts the first aqueous drainage device into the interior of the eye with its end in the subconjunctival space; the device does not include a reservoir to hold the fluid. The device… | 10 | $2,170 | $30.4K |
| 67917 | During this procedure, the provider performs an extensive repair of an ectropion, which is an outward turning of the lower eyelid and eyelashes, which can lead to excessive tearing and irritation of… | 50 | $560 | $28.9K |
| 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. | 20 | $1,540 | $26.1K |
Showing 1–10 of 20
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 20 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
20 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 66984 | 44 | 90 | 1,340 | $40 | $62.5K |
| V2785 | 1 | 10 | 10 | $4,050 | $56.8K |
| 66991 | 4 | 10 | 30 | $1,580 | $49.1K |
| 15823 | 3 | 10 | 60 | $510 | $32.6K |
| 66170 | 1 | 10 | 30 | $790 | $25.2K |
| 67041 | 1 | 10 | 20 | $1,260 | $22.7K |
| 67108 | 1 | 10 | 10 | $1,540 | $21.5K |
| 66982 | 3 | 10 | 30 | $200 | $21.3K |
| 0449T | 1 | 10 | 10 | $1,390 | $19.4K |
| 65756 | 1 | 10 | 10 | $1,230 | $17.3K |
Showing 1–10 of 20
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.
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… | 2,710 | $300 | $822.3K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 680 | $70 | $49K |
| 67228 | In retinopathy, tiny new vessels grow profusely and fibrous tissue proliferates in between the layers of the retina, which may extend into the optic nerve and vitreous, clear gel that fills the space… | 100 | $80 | $7.4K |
| 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… | 1,130 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 1,120 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Maine providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Maine median
5 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… | 2 | 30 | 220 | $280 | $186.7K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 1 | 10 | 100 | $80 | $21.8K |
| 67228 | In retinopathy, tiny new vessels grow profusely and fibrous tissue proliferates in between the layers of the retina, which may extend into the optic nerve and vitreous, clear gel that fills the space… | 1 | 10 | 100 | $80 | $7.4K |
| 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… | 1 | 10 | 270 | $1 | $1 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 1 | 10 | 260 | $0 | $0 |
Other providers in the same ZIP code as Eyecare Medical Group, ranked by combined Medicare and Medicaid revenue.
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