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NPI 1558436105 · Gardner, MA · Ophthalmologic Surgery Clinic/Center
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Cataract Laser Centercentral LLC is a ophthalmologic surgery clinic/center provider located in Gardner, Massachusetts. This profile covers 9 Medicare and 3 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 | Cataract Laser Centercentral LLC |
| Address | 95 Mechanic St |
| City | Gardner |
| State | MA |
| ZIP | 01440 |
| Taxonomy | Ophthalmologic Surgery Clinic/Center |
| NPI Enumerated | November 21, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.6M |
| Medicaid | $489.7K |
This practice operates squarely as an ophthalmologic surgery center with a heavy emphasis on cataract procedures and intraoperative ophthalmic drug use. Its Medicare top revenue drivers include 66984, J1096, and J1097, and Medicaid billing is dominated by 66984, consistent with an ambulatory surgical model focused on cataract extraction with lens insertion and adjunct intraoperative medications. The revenue totals on file are $1.6M for Medicare and $489.7K for Medicaid, indicating the bulk of its procedural volume and payments come from these cataract-related services.
Revenue concentration is high for both payers: the provider’s top three Medicare codes account for 83.5% of its total Medicare revenue, and the top three Medicaid codes account for 100.0% of its total Medicaid revenue. In particular, 66984 alone represents 59.9% of Medicare revenue ($961.1K) and 99.8% of Medicaid revenue ($489.3K), making the practice highly dependent on this single procedure for its public-payer income streams.
Payer mix shows Medicare as the larger revenue source in scale: Medicare revenue is $1.6M versus Medicaid revenue of $489.7K, so Medicare payments represent the primary public-payer contribution to the practice’s lifetime reported revenue. Medicaid is a meaningful but much smaller contributor and, given the near-total concentration in 66984 on the Medicaid side, is effectively single-procedure dependent.
Competitive standing for key Medicare codes is mixed but generally above average in placement: 66984 ranks #1891 of 15965 nationally (88th percentile; typical, unremarkable volume for this code), J1096 ranks #40 of 282 (86th percentile; typical, unremarkable volume for this code), and J1097 ranks #156 of 443 (65th percentile; typical, unremarkable volume for this code). These ranks indicate the provider is a higher-percentile biller of common cataract and intraoperative drug codes relative to national peers, but the data notes these volumes as “typical, unremarkable” for the codes, i.e., not an extreme outlier.
Within the state Medicaid market the provider is a notable performer for cataract surgery: 66984 ranks #9 of 63 in-state (87th percentile; typical, unremarkable volume for this code), making it one of the larger Medicaid cataract billers in Massachusetts by rank. The remaining Medicaid codes (G8918 and G8907) account for trivial revenue and are administrative/documentation codes, underscoring that Medicaid volume is operationally centered on the single surgical procedure.
Clinical/operational implications from the code mix: significant use of J1096 (dexamethasone lacrimal ophthalmic insert) and J1097 (phenylephrine/ketorolac irrigation solution) alongside 66984 suggests routine adoption of intraoperative adjuncts or postoperative ocular drug delivery as part of the cataract workflow. The presence of procedural codes such as 66991 and 66982 and a small amount of 67042 indicates the center performs some complex cataract/IOL and posterior-segment interventions at modest volumes, implying capability beyond only basic cataract extraction.
The practice’s lifetime NPI shows long tenure: enumerated on 2006-11-21 (~20 years ago), which supports interpretation of the billing pattern as representative of an established ambulatory ophthalmic surgery operation rather than a new entrant or transient billing anomaly. Longevity combined with concentrated procedure volumes suggests an enduring, focused service line.
Concentration risk is material: because 66984 accounts for nearly all Medicaid revenue (99.8%) and the top three Medicare codes account for 83.5% of Medicare revenue, payment policy changes or utilization shifts for cataract surgery or those specific intraoperative drugs could disproportionately affect this provider’s public-payer revenue. Analysts should treat reimbursement trends for 66984 and the associated intraoperative drug codes as primary levers when projecting revenue or assessing vulnerability.
Medicare revenue breakdown by CPT/HCPCS procedure code.
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The CPT/HCPCS codes generating the most Medicare revenue for this provider.
9 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… | 1,090 | $890 | $961.1K |
| J1096 | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg | 2,420 | $100 | $239.4K |
| J1097 | phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml | 1,820 | $80 | $140.4K |
| 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… | 40 | $2,660 | $111.7K |
| 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… | 80 | $890 | $72.7K |
| 67042 | In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina… | 20 | $1,600 | $30.4K |
| 66710 | The provider destroys a portion of ciliary body using a laser beam. This procedure decreases the fluid production in the eye, thereby decreasing intraocular pressure. | 30 | $720 | $23.1K |
| 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 | $550 | $15.3K |
| 67908 | The provider performs a procedure such as the Fasanella–Servat procedure, which involves resection and plication of the levator/Muller muscles along with the tarsus and the conjunctiva to treat… | 20 | $580 | $11K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 9 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.
3 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… | 1,710 | $290 | $489.3K |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 1,010 | $1 | $1K |
| 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… | 990 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Massachusetts providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Massachusetts median
3 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… | 9 | 60 | 330 | $380 | $352.9K |
| 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… | 11 | 40 | 350 | $1 | $560 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 7 | 20 | 390 | $1 | $160 |
Other providers in the same ZIP code as Cataract Laser Centercentral LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Henry Heywood Memorial Hospital | MA | General Acute Care Hospital | $0 | $54.5M |
| Massachusetts Correctional Industries | MA | Eyewear Supplier | $0 | $52.8M |
| Gaamha, Inc | MA | Non-emergency Medical Transport (VAN) | $0 | $11.8M |
| Community Health Connections, Inc. | MA | Federally Qualified Health Center (FQHC) | $0 | $9M |
| Wood's Ambulance Inc. | MA | Ambulance | $1.1M | $4.8M |
| Thomas Miller | MA | Family Medicine Physician | $364.5K | $448.2K |
| Tricia Vorderstrasse | MA | Family Medicine Physician | $256.7K | $217.4K |
| Shields Imaging At Heywood Healthcare LLC | MA | Magnetic Resonance Imaging (MRI) Clinic/Center | $115.6K | $194K |
| Victor Zota | MA | Anatomic Pathology & Clinical Pathology Physician | $101.3K | $59.1K |
| Jared Toman | MA | Orthopaedic Surgery Physician | $63.7K | $48.1K |
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