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NPI 1679728901 · West Orange, NJ · Ambulatory Surgical Clinic/Center
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Essex Specialized Surgical Institute LLC is a ambulatory surgical clinic/center provider located in West Orange, New Jersey. This profile covers 16 Medicare and 6 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 | Essex Specialized Surgical Institute LLC |
| Address | 475 Prospect Ave |
| City | West Orange |
| State | NJ |
| ZIP | 07052 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | December 1, 2008 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.7M |
| Medicaid | $2M |
ESSEX SPECIALIZED SURGICAL INSTITUTE LLC operates as an Ambulatory Surgical Clinic/Center with its billing mix dominated by ophthalmic surgical procedures; the top Medicare and Medicaid codes (66984 and 66982) are both cataract extraction and intraocular lens procedures and 65820 is an incisional limbal procedure typically used for pediatric congenital glaucoma, together indicating the practice’s primary service line is high-volume cataract and related anterior-segment glaucoma surgery. The code descriptions and claim volumes suggest a surgical ambulatory center model focused on same-day ophthalmic operations rather than broad multispecialty outpatient care.
Revenue concentration on Medicare is pronounced: the top 3 Medicare codes by revenue account for 87.9% of this provider's total Medicare revenue, led by 66984 ($2M revenue, 55.1% of Medicare revenue), followed by 66982 ($607K, 16.5%) and 65820 ($597.8K, 16.3%). This concentration indicates Medicare income is heavily dependent on a narrow set of cataract and limbal glaucoma procedures.
Medicaid revenue is even more concentrated: the top 3 Medicaid codes by revenue account for 99.6% of this provider's total Medicaid revenue, with 66984 generating $1.4M (69.8% of Medicaid revenue), 66982 generating $588K (28.7%), and 65820 contributing $23.4K (1.1%). The Medicaid activity is dominated by large volumes of cataract procedures (6.2K claims for 66984 and 2.7K claims for 66982), signaling reliance on these two procedures for nearly all state-plan revenue.
On national competitive standing for Medicare, the provider is a clear high-volume outlier for key ophthalmic procedures: 66982 ranks #11 of 4580 providers nationally (100th percentile; extreme outlier) and 65820 ranks #1 of 1249 providers nationally (100th percentile; extreme outlier), while 66984 ranks #748 of 15965 (95th percentile; notably above typical national volume). These rank positions indicate the practice is a major national-volume provider for complex cataract and limbal incision procedures rather than a modest local operator.
State-level competitive signals for Medicaid mirror the Medicare pattern for cataract surgery: 66984 ranks #3 of 63 in-state (97th percentile; notably above typical state volume) and 66982 ranks #2 of 10 in-state (89th percentile), showing the provider is among the top-volume Medicaid cataract surgeons in New Jersey. Additionally, two encounter/quality codes (G8918 and G8907) show 1.6K claims each with $0 revenue and rank #1 in-state (100th percentile; extreme outlier), which reflects heavy use of reporting/quality codes that do not generate direct Medicaid revenue but may reflect standardized documentation practices.
The payer mix shows Medicare scale exceeds Medicaid but both are material: total Medicare revenue is $3.7M versus total Medicaid revenue of $2M, so the practice is not single-payer dependent and draws substantial income from both federal and state programs. Given the high revenue concentration on the same cataract codes across both payers, shifts in reimbursement or referral patterns for cataract services could materially affect overall revenue.
There are notable average-paid differences between payers on identical procedures that could affect margins and contracting strategy: for 66984 the Medicare average paid/claim is $850 while Medicaid average paid/claim is $229, and for 66982 Medicare avg paid/claim is $818 versus Medicaid $215. These payer-level price differentials suggest revenue per case varies substantially by payer even when procedural volume is high, which is important for cost and profitability analysis at the service-line level.
The provider’s NPI was enumerated on 2008-12-01 (~18 years ago), indicating an established presence in the market; this tenure aligns with the high-volume rankings observed for multiple cataract and glaucoma codes and supports the interpretation of an experienced specialty surgical center with sustained procedural throughput.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
16 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… | 2,380 | $850 | $2M |
| 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… | 740 | $820 | $607K |
| 65820 | The provider incises the limbus to improve drainage of aqueous humor in the eye. This procedure is typically performed on children, usually to treat congenital glaucoma. | 380 | $1,590 | $597.8K |
| 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… | 50 | $2,680 | $123.1K |
| 67904 | The provider repairs a drooping eyelid by tightening the levator muscle that controls eyelid movement to improve cosmetic appearance or remove the obstruction to a patient’s vision. He accesses the… | 100 | $550 | $57.1K |
| 66172 | In this procedure, the provider creates a fistula and removes part of the trabecular meshwork from a previous surgery to treat glaucoma and relieve intraocular pressure. He injects antifibrotic… | 50 | $820 | $41.9K |
| 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. | 30 | $1,610 | $40.2K |
| 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 | $38.4K |
| 67108 | The provider repairs a detached retina using heat produced by a laser beam or by freezing the tissues. He may attach a scleral buckle to simplify the passage of fluid through and behind the retina or… | 20 | $1,610 | $35.4K |
| 67113 | The provider repairs a complicated detached retina. He removes vitreous humor, the gelatinous material that gives shape to the eye, and peels the retinal membrane. He reattaches the retina with… | 20 | $1,620 | $27.5K |
Showing 1–10 of 16
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 16 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
16 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 66984 | 3 | 370 | 100 | $670 | $141.2K |
| 66991 | 9 | 50 | 30 | $2,020 | $82.9K |
| 65820 | 1 | 60 | 30 | $1,130 | $50.9K |
| 66982 | 1 | 160 | 30 | $740 | $40.7K |
| 66172 | 2 | 10 | 50 | $920 | $35.9K |
| 67904 | 4 | 20 | 40 | $600 | $32.3K |
| 66180 | 9 | 10 | 20 | $1,730 | $31.2K |
| 67042 | 7 | 20 | 20 | $1,250 | $30.1K |
| 67108 | 5 | 10 | 20 | $920 | $23.1K |
| 67113 | 3 | 10 | 20 | $1,180 | $20K |
Showing 1–10 of 16
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.
6 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… | 6,240 | $230 | $1.4M |
| 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… | 2,740 | $220 | $588K |
| 65820 | The provider incises the limbus to improve drainage of aqueous humor in the eye. This procedure is typically performed on children, usually to treat congenital glaucoma. | 390 | $60 | $23.4K |
| 0191T | N/A | 70 | $110 | $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… | 1,620 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 1,610 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other New Jersey providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New Jersey median
6 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… | 3 | 60 | 110 | $370 | $327.3K |
| 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… | 2 | 10 | 80 | $330 | $266.2K |
| 65820 | The provider incises the limbus to improve drainage of aqueous humor in the eye. This procedure is typically performed on children, usually to treat congenital glaucoma. | 2 | 10 | 270 | $170 | $50.4K |
| 0191T | N/A | 2 | 10 | 70 | $100 | $12.5K |
| 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 | 30 | 80 | $1 | $20 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 1 | 20 | 40 | $1 | $1 |
Other providers in the same ZIP code as Essex Specialized Surgical Institute LLC, ranked by combined Medicare and Medicaid revenue.
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