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NPI 1386958064 · Bettendorf, IA · Ophthalmology Physician
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Carlton Fenzl is a ophthalmology physician provider located in Bettendorf, Iowa. This profile covers 25 Medicare and 2 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 | Individual |
| Organization | Carlton Fenzl |
| Address | 777 Tanglefoot Ln |
| City | Bettendorf |
| State | IA |
| ZIP | 52722 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | August 4, 2010 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.1M |
| Medicaid | $950 |
Medicare-dominant revenue profile: this provider reports $1.1M in total Medicare revenue versus $953 in total Medicaid revenue, indicating an effectively Medicare-focused practice with very limited Medicaid billing on file. The Medicaid sum is negligible relative to Medicare, so payer mix and growth strategies are likely to be driven by Medicare volumes and reimbursement trends rather than Medicaid participation.
Top-code concentration in Medicare: three CPT/HCPCS codes—J0178, 66984, and J2777—account for 66.6% of this provider's Medicare revenue, signaling that intravitreal pharmacologic treatments and cataract surgery are the primary revenue drivers. The largest single Medicare line is J0178 (Injection, aflibercept) with $395.8K in revenue (35.0% of Medicare revenue), underscoring dependency on high-cost injections.
Clinical/service-line footprint: the code mix (high revenue from J0178 and J2777 plus significant billing for 66984 and IOL-related codes like 92136) indicates a dual retina and cataract surgery practice model—frequent intravitreal injections paired with surgical cataract procedures and IOL calculations. High counts for injection and imaging codes (e.g., 572 claims for J0178; 5K claims for J2777; 573 claims for 92136) point to a combination of office-based retina therapeutics and perioperative cataract services.
Competitive standing on Medicare for top codes: the provider’s volume on J0178 ranks #1807 of 3204 (44th percentile) and on J2777 ranks #1533 of 2039 (25th percentile), both characterized as typical, unremarkable national volumes; by contrast, cataract surgery code 66984 ranks #2759 of 15965 (83th percentile), indicating comparatively stronger positioning in cataract procedural volume versus peers. Overall, the provider is a modest participant nationally on injection codes but relatively more active in cataract surgery volume.
Notable statistical outliers and high-utilization signals: the provider reports 230 claims for 99204 and is labeled an "extreme outlier, far above typical national volume" at the 99th percentile for that new-patient E/M code, which may reflect an atypically high number of high-complexity new office evaluations relative to national peers. Additionally, 92136 ranks in the 95th percentile (notably above typical national volume), reinforcing a workflow centered on IOL calculations and cataract planning.
Medicaid billing concentrated in basic office and vision-testing codes: Medicaid revenue is $953 in total, with 92015 accounting for $774 (79.6% of Medicaid revenue) and 99213 accounting for $198 (20.4%); the precomputed top-3 Medicaid share is 100.0%, indicating essentially all Medicaid revenue comes from routine refraction and established-patient E/M visits. Both Medicaid codes rank low in-state (92015 at the 17th percentile, 99213 at the 7th percentile), so the provider is not a major Medicaid participant in Iowa for these services.
Operational implications for service capacity: high claim counts for intravitreal injection codes (572 for J0178 and 558 for 67028) and for imaging/measurement codes (573 for 92136; 447 for 92134) imply steady throughput of retina patients requiring repeated visits and imaging, which suggests operational emphasis on efficient clinic flow and injection-visit capacity. The significant revenue concentration in a small number of high-cost drugs and cataract procedures exposes the practice to shifts in drug utilization and surgical referral patterns.
Tenure and stability: the provider’s NPI was enumerated on 2010-08-04 (~16 years ago), indicating a long-established presence in the market. This tenure, combined with a concentrated Medicare revenue base, suggests an established clinical practice with sustained Medicare-facing activity rather than a newly launched 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.
25 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| J0178 | Injection, aflibercept, 1 mg | 570 | $690 | $395.8K |
| 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… | 550 | $390 | $212.9K |
| J2777 | Injection, faricimab‑svoa, 0.1 mg | 4,980 | $30 | $144.4K |
| J2778 | Injection, ranibizumab, 0.1 mg | 500 | $180 | $89.1K |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 350 | $170 | $58.1K |
| 67028 | The provider injects a medication into the vitreous chamber of the eye as an isolated procedure or a separate procedure unrelated to any other procedure being performed on the eye. | 560 | $90 | $50.2K |
| 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… | 560 | $90 | $48.9K |
| 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… | 230 | $110 | $24.8K |
| 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… | 310 | $60 | $17.9K |
| 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… | 570 | $30 | $17.2K |
Showing 1–10 of 25
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 25 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
25 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J2777 | 21 | 20 | 43,140 | $30 | $1.7M |
| J0178 | 21 | 40 | 640 | $690 | $760.2K |
| J2778 | 15 | 20 | 780 | $180 | $259.9K |
| Q5124 | 4 | 10 | 740 | $170 | $130.5K |
| 67028 | 25 | 60 | 420 | $80 | $80.6K |
| 66984 | 24 | 340 | 50 | $340 | $50.4K |
| 66982 | 55 | 60 | 40 | $450 | $39K |
| 65756 | 7 | 10 | 20 | $1,070 | $28.9K |
| 92014 | 362 | 500 | 200 | $70 | $19.8K |
| 99214 | 396 | 4,690 | 100 | $70 | $14.4K |
Showing 1–10 of 25
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.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 92015 | The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced. | 40 | $20 | $770 |
| 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… | 20 | $10 | $200 |
How this provider's Medicaid billing volume and revenue compare to other Iowa providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Iowa median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 1,215 | 1,310 | 760 | $20 | $153.1K |
| 92015 | The provider determines the process of determining if a patient's vision is less than 20/20 and by what amount so that corrective lenses or contact lenses can be prescribed and produced. | 345 | 420 | 310 | $10 | $5.8K |
Other providers in the same ZIP code as Carlton Fenzl, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| New Choices Inc | IA | Developmentally Disabled Services Day Training Agency | $0 | $72.6M |
| Bettendorf Community School District | IA | Local Education Agency (LEA) | $0 | $7.4M |
| New Choices | IA | Community/Behavioral Health Agency | $0 | $6.9M |
| Trinity Medical Center | IA | General Acute Care Hospital | $0 | $5.2M |
| Helping Hands Transporting Services,llc | IA | Non-emergency Medical Transport (VAN) | $0 | $3.5M |
| Gengastro LLC | IA | Ambulatory Surgical Clinic/Center | $1.1M | $1M |
| Martin O'malley | IA | Ophthalmology Physician | $1.9M | $2.7K |
| New Choices LLC | IA | Home Health Agency | $0 | $1.9M |
| Genesis Health System | IA | Home Health Agency | $0 | $1.8M |
| Hand In Hand | IA | Respite Care | $0 | $1.5M |
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