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NPI 1487655379 · Great Falls, MT · Ophthalmology Physician
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David Boes is a ophthalmology physician provider located in Great Falls, Montana. This profile covers 14 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 | Individual |
| Organization | David Boes |
| Address | 2800 11th Ave S |
| City | Great Falls |
| State | MT |
| ZIP | 59405 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | August 2, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.1M |
| Medicaid | $50 |
This clinician is a cataract-focused ophthalmologist by CPT mix: the largest Medicare revenue line is 66984 (phacoemulsification with IOL) which accounts for $516.5K and 47.4% of the provider's total Medicare revenue, complemented by high-revenue related cataract codes 66821 and 66982. The presence of 92136 and 92134 (ocular biometry and posterior segment imaging) and several E/M codes indicates the practice performs preoperative testing and routine ophthalmic follow-up in addition to surgical volume. These patterns are consistent with an ophthalmic practice organized around cataract surgery plus associated diagnostic and office care.
Revenue concentration on Medicare is highly concentrated: the precomputed top-3 Medicare codes account for 75.6% of total Medicare revenue, indicating that a small set of procedures (chiefly cataract surgery and related services) drive most of the Medicare earnings. For Medicaid the top-3 codes account for 100.0% of Medicaid revenue, but Medicaid revenue is negligible in scale overall.
Payer mix is effectively single-payer in economic importance: lifetime Medicare revenue is $1.1M versus lifetime Medicaid revenue of $51, so Medicare overwhelmingly dominates this provider’s public-payer receipts and the practice is effectively Medicare-driven. Medicaid activity exists but at a de minimis level (Medicaid revenue $51), suggesting little engagement with Medicaid patients or limited Medicaid billing.
Competitive standing for key Medicare codes varies: for 66984 this provider ranks #1515 of 15965 (91th percentile), which places them well above median national providers in volume for standard cataract extractions but not among the very highest-volume national centers. For 66821 the provider ranks #171 of 10087 (98th percentile), indicating a notably above-typical national volume for posterior capsulotomy procedures and relative regional specialization in that service. In contrast, the high count for 99204 (rank #6 of 227068, 100th percentile) marks the provider as an extreme outlier nationally for new-patient level-4 E/M visits compared with peers.
The provider shows multiple code-level statistical outliers that reflect operational emphasis: 99204 and 92136 are labeled as “extreme outlier” with 99204 ranking at the 100th percentile nationally and 92136 ranking at the 100th percentile as well, implying exceptionally high volumes of moderate-complexity new-patient visits and IOL biometry relative to national peers. 66821 is “notably above typical national volume,” highlighting a particular strength in laser posterior capsulotomy. Other codes such as 66982 (99th percentile) also show elevated activity consistent with more complex cataract cases.
Operational footprint and workflow inference: the combination of high-volume surgical codes (66984, 66982), substantial IOL measurement claims (92136), and a large number of new-patient E/Ms (99204) suggests the practice manages surgical scheduling, preoperative workup, and new patient intake in-house rather than referring these functions out. This integrated pattern supports a full-service cataract surgery practice model that likely performs its own diagnostics and pre-op consultations.
Tenure and stability: the provider’s NPI was enumerated ~21 years ago (2005-08-02), indicating long-standing presence in the market which is consistent with sustained surgical volumes reported to Medicare. That tenure supports interpretation that the current code mix reflects an established clinical practice rather than a transient billing pattern.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
14 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… | 1,460 | $360 | $516.5K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 600 | $310 | $183.9K |
| 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… | 1,020 | $120 | $123.9K |
| 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… | 240 | $490 | $116.6K |
| 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… | 1,790 | $30 | $55.4K |
| 92014 | An ophthalmologist sees an established patient for a comprehensive level eye examination. Generally, a patient is considered to be "established" if the same physician, or any physician in the group… | 580 | $90 | $50.9K |
| 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… | 80 | $460 | $35.3K |
| 92134 | The provider performs computerized diagnostic imaging of the retina in the posterior segment (back part) of the eye, interprets the data, and provides a report. The service may be on one or both eyes. | 90 | $30 | $2.6K |
| 92020 | The provider examines the angle of the anterior chamber of the eye (the angle where the iris and cornea meet) using a special lens (goniolens) and slit–lamp or operating microscope to diagnose and… | 70 | $20 | $1.4K |
| 11440 | The provider excises a benign (noncancerous) lesion including margins from the face, ears, eyelids, nose, lips, or mucous membrane that is 0.5 cm in diameter or less and also performs a simple… | 10 | $90 | $1.2K |
Showing 1–10 of 14
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 14 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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 |
|---|---|---|---|---|
| 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… | 50 | $1 | $50 |
How this provider's Medicaid billing volume and revenue compare to other Montana providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Montana median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 2 | 10 | 50 | $30 | $18.1K |
Other providers in the same ZIP code as David Boes, ranked by combined Medicare and Medicaid revenue.
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