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NPI 1891701736 · Homer, AK · Ophthalmology Physician
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Garret Sitenga is a ophthalmology physician provider located in Homer, Alaska. This profile covers 8 Medicare and 7 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 | Garret Sitenga |
| Address | 4381 E Hill Rd |
| City | Homer |
| State | AK |
| ZIP | 99603 |
| Taxonomy | Ophthalmology Physician |
| NPI Enumerated | July 31, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $326.9K |
| Medicaid | $108.5K |
GARRET SITENGA is an ophthalmology physician with a long Medicare/Medicaid billing history, having an NPI enumerated on 2006-07-31 (~20 years ago), indicating multi-decade presence in the market and sustained participation in public programs. This tenure supports the interpretation that billing patterns represent an experienced solo or small-group ophthalmic practice rather than a newly established provider.
Medicare revenue is materially larger than Medicaid for this provider: total Medicare revenue is $326.9K versus total Medicaid revenue of $108.5K, indicating Medicare is the primary payer and accounts for roughly three times the revenue of Medicaid on an absolute basis. This payer mix suggests the provider’s patient panel or case mix skews toward Medicare-eligible patients, typical for ophthalmology practices with substantial cataract and age-related care.
Revenue concentration is high on both payers. For Medicare, the precomputed top 3 Medicare codes account for 72.4% of total Medicare revenue, showing that a small set of services (notably 92014 and 66984 among them) drive the majority of Medicare income. For Medicaid, the top 3 Medicaid codes account for 80.3% of total Medicaid revenue, indicating even greater dependence on a small number of service lines in the Medicaid population.
The provider’s Medicare activity is strongly centered on comprehensive and cataract-related procedures. Code 92014 alone generated $102.6K (31.3% of Medicare revenue) and ranks in the 95th national percentile, described as notably above typical national volume—this signals a high-volume established patient exam practice. Code 66984 contributed $93.1K (28.4% of Medicare revenue) and sits at a typical national volume percentile (63rd), indicating routine cataract surgery volume that complements the high 92014 exam volume.
Procedure mix and relative revenue shares indicate a service-line focus on cataract surgical care and associated pre-/post-operative testing. High Medicare revenue from 66984 (cataract extraction with intraocular lens insertion) and supporting codes such as 76519 (IOL biometry) and 66821 (YAG capsulotomy) show the practice performs surgical cataract workflows end-to-end. Medicaid revenues also reflect exam and refraction services (92014, 92015) and some surgical preparatory activity (92004, 76519), but at lower absolute dollars, consistent with a practice that treats more surgical Medicare patients.
Competitive standing is mixed by payer and code. Nationally, the provider ranks highly for some exam codes—92014 ranks #1604 of 35415 (95th percentile) and 92004 ranks #588 of 26467 (98th percentile), marking the provider as a major outlier for comprehensive ophthalmologic exams relative to national peers. In contrast, cataract surgery code 66984 is around the 63rd percentile nationally (rank #5877 of 15965), which is an unremarkable, routine surgical volume compared with specialized surgical centers.
In-state Medicaid comparisons show this provider is a leading distributor of exam services within Alaska for certain codes but not uniformly dominant. Medicaid 92014 is $54.9K (50.6% of Medicaid revenue) and ranks #42 of 102 in-state (59th percentile), indicating typical state-level volume rather than clear dominance. Conversely, some Medicaid procedure volumes such as 76519 show unique positioning (rank #1 of 1 in-state), but the Medicaid dollar amount for that code is negligible ($372), so this does not materially change competitive impact.
Operational risk and concentration considerations arise from the heavy dependence on a few high-revenue codes across both payers. With the top three Medicare codes accounting for 72.4% of Medicare revenue and the top three Medicaid codes accounting for 80.3% of Medicaid revenue, fluctuations in exam or cataract surgery demand, reimbursement changes, or referral patterns could substantially affect practice revenue. Diversification of services or payers would reduce exposure.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
8 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 1,020 | $100 | $102.6K |
| 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… | 180 | $530 | $93.1K |
| 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… | 510 | $80 | $41.5K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 260 | $120 | $30K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 90 | $280 | $24.3K |
| 92083 | The provider may use one or more methods to determine the extent of a patient's visual field of one or both eyes; he interprets the results and prepares a report. Report this code for an extended… | 290 | $50 | $14.5K |
| 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… | 20 | $720 | $12.9K |
| 76519 | The provider uses A scan ultrasound echography to measure the axial length of the eye and determine the intraocular lens, or IOL calculation prior to cataract surgery. | 200 | $40 | $8.5K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 8 CPT/HCPCS codes.
View: State1 / 2
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.
7 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 650 | $90 | $54.9K |
| 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. | 730 | $30 | $18.3K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 90 | $150 | $13.9K |
| 92012 | For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any… | 160 | $70 | $11.8K |
| 92340 | Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal | 120 | $50 | $5.3K |
| 92341 | Code 92341 describes the fitting of eyeglasses of bifocal type, i.e., the lens has two separate areas of focus such as an area which gives best near vision and another area giving best far vision. | 70 | $60 | $3.9K |
| 76519 | The provider uses A scan ultrasound echography to measure the axial length of the eye and determine the intraocular lens, or IOL calculation prior to cataract surgery. | 10 | $30 | $370 |
How this provider's Medicaid billing volume and revenue compare to other Alaska providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Alaska median
7 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 42 | 100 | 460 | $250 | $317.6K |
| 92004 | The provider performs a comprehensive level ophthalmological evaluation of a new patient and initiates a diagnostic and treatment program for one or more visits. | 67 | 100 | 350 | $260 | $254.6K |
| 92012 | For this CPT code, an Ophthalmologist sees an established patient for an intermediate level eye examination. Generally, a patient is considered to be "established" if the same physician, or any… | 13 | 30 | 160 | $310 | $209.3K |
| 92340 | Code 92340 describes the fitting of eyeglasses, except for aphakia (absence of the crystalline lens as after cataract surgery); monofocal | 55 | 60 | 900 | $80 | $174.2K |
| 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. | 62 | 110 | 1,210 | $30 | $82.6K |
| 92341 | Code 92341 describes the fitting of eyeglasses of bifocal type, i.e., the lens has two separate areas of focus such as an area which gives best near vision and another area giving best far vision. | 25 | 40 | 160 | $60 | $20.7K |
| 76519 | The provider uses A scan ultrasound echography to measure the axial length of the eye and determine the intraocular lens, or IOL calculation prior to cataract surgery. | 1 | 10 | 10 | $30 | $370 |
Other providers in the same ZIP code as Garret Sitenga, ranked by combined Medicare and Medicaid revenue.
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