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NPI 1770537227 · Waltham, MA · Ophthalmologic Surgery Clinic/Center
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West Suburban Eye Surgery Center LLC is a ophthalmologic surgery clinic/center provider located in Waltham, Massachusetts. This profile covers 22 Medicare and 4 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 | West Suburban Eye Surgery Center LLC |
| Address | 1440 Main St |
| City | Waltham |
| State | MA |
| ZIP | 02451 |
| Taxonomy | Ophthalmologic Surgery Clinic/Center |
| NPI Enumerated | May 20, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.9M |
| Medicaid | $1.2M |
Service-line profile: The provider operates as an ophthalmologic surgery center focused on high-volume cataract care and related anterior-segment procedures. Medicare billing is dominated by cataract extraction with intraocular lens insertion (66984: 3.3K claims, $871 avg paid/claim, $2.9M revenue, 59.4% of Medicare revenue) and complex lens procedures (66982: 402 claims, $869 avg paid/claim, $349.3K revenue), while ancillary ophthalmic medications and intraoperative irrigation (J1096, J1097) also appear among top Medicare billings, consistent with an ASC oriented to cataract and intraocular work.
Medicare revenue concentration: This provider’s top three Medicare codes account for 74.2% of its total Medicare revenue, driven primarily by 66984 ($2.9M, 59.4% of Medicare revenue) with J1096 ($370.7K, 7.6%) and 66982 ($349.3K, 7.2%) completing the trio. That level of concentration indicates financial dependence on a narrow set of high-volume cataract and related procedure codes.
Medicaid revenue concentration: On the Medicaid side the top three codes are even more dominant, accounting for 99.8% of total Medicaid revenue; 66984 alone represents $1.1M and 91.9% of Medicaid revenue with 66982 contributing $91.6K (7.8%). The Medicaid profile mirrors Medicare in being overwhelmingly cataract-centric, with safety/documentation G-codes appearing only as very small dollar items.
Payer mix and scale: The practice reports $4.9M in total Medicare revenue versus $1.2M in total Medicaid revenue, making Medicare the substantially larger payer by scale while Medicaid is a meaningful secondary payer for cataract volume. This mix suggests the center’s primary revenue base is older Medicare beneficiaries while Medicaid contributes a smaller but concentrated share of case volume for the same procedural lines.
Competitive standing — Medicare national position: For key cataract and medication codes the practice ranks strongly against national peers: 66984 ranks #396 of 15965 providers nationally (98th percentile; notably above typical national volume for this code), 66982 ranks #24 of 4580 (99th percentile; notably above typical national volume for this code), and J1096 ranks #20 of 282 providers nationally (93th percentile; notably above typical national volume for this code). These placements identify the center as a high-volume national outlier for cataract and related ophthalmic supply codes.
Competitive standing — Medicaid in-state position: Within the state, 66984 ranks #5 of 63 providers in-state (94th percentile; notably above typical state volume for this code) and 66982 ranks #3 of 9 providers in-state (75th percentile; typical, unremarkable volume for this code), indicating a leading role in state-level cataract surgery volume. The Medicaid ranks reinforce that the center is a prominent regional provider for cataract procedures.
Statistical outliers and specialty signals: Several codes show unusually high standing relative to peers, signaling special procedural capabilities: 65820 is labeled an "extreme outlier" with 138 claims ($213.2K, 4.4% of Medicare revenue), and 65772 is ranked #1 of 16 providers nationally (100th percentile; notably above typical national volume for this code) with 225 claims ($41.4K). The presence of V2785 (corneal tissue processing) and corneal transplant code 65756 further indicates capability in corneal procedures beyond routine cataract work.
Tenure and contracting implication: The NPI was enumerated on 2006-05-20 (~20 years ago), indicating an established surgical center with long operational history. Combined with concentrated, high-volume cataract billing and top-percentile rankings, the center presents as a mature, high-throughput ophthalmic ASC that could be prioritized in network conversations for cataract and anterior-segment surgical contracts.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
22 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… | 3,310 | $870 | $2.9M |
| J1096 | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg | 3,740 | $100 | $370.7K |
| 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… | 400 | $870 | $349.3K |
| 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… | 100 | $2,650 | $259.9K |
| J1097 | phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml | 2,860 | $80 | $217.7K |
| 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. | 140 | $1,550 | $213.2K |
| 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. | 60 | $1,500 | $88.2K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 370 | $220 | $79.7K |
| V2785 | Processing, preserving and transporting corneal tissue | 20 | $3,750 | $74.9K |
| 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… | 30 | $1,500 | $50.8K |
Showing 1–10 of 22
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 22 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
22 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J1096 | 1 | 10 | 2,200 | $100 | $189.1K |
| 66984 | 12 | 330 | 170 | $200 | $143.2K |
| V2785 | 2 | 10 | 20 | $3,630 | $101.6K |
| 66991 | 6 | 50 | 30 | $1,640 | $70.7K |
| J1097 | 1 | 10 | 280 | $80 | $62.6K |
| 65820 | 1 | 30 | 30 | $1,050 | $37.9K |
| 66982 | 2 | 140 | 30 | $680 | $36.9K |
| 0449T | 3 | 10 | 20 | $1,550 | $32.5K |
| 66174 | 11 | 10 | 20 | $910 | $30K |
| 67042 | 7 | 30 | 20 | $1,170 | $25.7K |
Showing 1–10 of 22
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.
4 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… | 3,960 | $270 | $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… | 340 | $270 | $91.6K |
| 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… | 1,960 | $1 | $2K |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 1,960 | $1 | $2K |
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
4 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… | 5 | 60 | 330 | $380 | $352.9K |
| 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… | 3 | 10 | 110 | $430 | $152.3K |
| 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… | 5 | 40 | 350 | $1 | $560 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 2 | 20 | 390 | $1 | $160 |
Other providers in the same ZIP code as West Suburban Eye Surgery Center LLC, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Jewish Family & Children's Service | MA | Foster Care Agency | $0 | $11.6M |
| Exosome Diagnostics, Inc. | MA | Clinical Medical Laboratory | $8.9M | $310.6K |
| Children's Dental Of Waltham, P.C. | MA | General Practice Dentistry | $0 | $7.2M |
| Quantum Pathology, LLC | MA | Anatomic Pathology & Clinical Pathology Physician | $3.1M | $913.7K |
| Boston Eye Surgery & Laser Center Trust | MA | Ambulatory Surgical Clinic/Center | $2.4M | $67.1K |
| Peter Chang | MA | Ophthalmology Physician | $1.3M | $0 |
| Boston Out-patient Surgical Suites, LLC | MA | Ambulatory Surgical Clinic/Center | $693.9K | $0 |
| Stephen Anesi | MA | Ophthalmology Physician | $550.8K | $0 |
| Geoffrey Van Flandern | MA | Orthopaedic Surgery Physician | $408.1K | $0 |
| Ambika Hoguet | MA | Ophthalmology Physician | $375.6K | $0 |
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