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NPI 1952360059 · Waterville, ME · Ambulatory Surgical Clinic/Center
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Maine Eye Care Associates is a ambulatory surgical clinic/center provider located in Waterville, Maine. This profile covers 5 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 | Maine Eye Care Associates |
| Address | 325a Kennedy Memorial Dr |
| City | Waterville |
| State | ME |
| ZIP | 04901 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | March 20, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $980.4K |
| Medicare | $479K |
Clinical service mix is concentrated in cataract surgery and related anterior-segment procedures, consistent with the listed taxonomy of Ambulatory Surgical Clinic/Center. The provider’s top reported CPTs include 66984, 66982, and 66821 across payers, and the presence of eyelid procedures such as 67950 and 67904 in Medicare claims indicates a mix of routine cataract work plus some oculoplastic services. This code mix is typical of a surgical eye practice focused on outpatient lens replacement and secondary capsulotomy care.
Medicare revenue is highly concentrated in a single procedure family: the top three Medicare codes account for 94.1% of this provider’s total Medicare revenue, with 66984 alone representing 84.9% of Medicare receipts. That concentration means most Medicare dollars flow from routine extracapsular cataract extraction with IOL placement rather than from a broad basket of ophthalmic services.
Medicaid revenue is even more concentrated: the top three Medicaid codes account for 100.0% of Medicaid revenue, and 66984 alone represents 98.8% of this provider’s Medicaid receipts. The Medicaid book of business is therefore dominated by one procedure (66984), creating substantial single-code dependence on state-paid cataract procedures.
Payer mix favors Medicaid by scale: the provider reported Total Medicare revenue of $479K versus Total Medicaid revenue of $980.4K, and Medicaid claims volume for the leading cataract code is much larger (66984: 3.3K Medicaid claims vs 518 Medicare claims). This indicates the practice’s revenue base is larger on the Medicaid side and that Medicaid volume drives the majority of overall case throughput.
Competitive standing diverges by payer: for Medicare the provider’s volume in 66984 ranks #2852 of 15965 providers nationally and is described as typical/unremarkable, indicating it is not a dominant national player for that code. By contrast, for Medicaid the provider’s 66984 activity ranks #1 of 26 in-state and is labeled an extreme outlier, far above typical state volume, identifying the practice as a dominant statewide supplier of that specific cataract service.
Operational/financial sensitivity is elevated because a single procedure drives most revenue across both payers: given that the top three Medicare codes account for 94.1% of Medicare revenue and the top three Medicaid codes account for 100.0% of Medicaid revenue, changes in reimbursement, referral patterns, or clinical guidelines for cataract surgery could materially affect performance. Diversification into additional procedures or payers would reduce that concentration risk.
Medicaid billing shows a pattern of submitting required facility/quality codes that carry no payment: G8907 and G8918 each appear with 797 Medicaid claims and $0 average paid/claim, which likely reflect standardized reporting of perioperative safety/antibiotic documentation rather than direct revenue drivers. These zero-dollar quality codes are common for facility reporting but should be tracked insofar as they reflect compliance and case volume rather than reimbursement.
The provider is long-tenured in the NPI registry (enumerated 2006-03-20, ~20 years ago), which supports the interpretation that the concentrated cataract business and the high Medicaid cataract volume represent an established referral and payer relationship rather than a short-term fluctuation. Tenure combined with the in-state dominance for 66984 suggests entrenched positioning in the local surgical cataract market.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
5 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… | 520 | $790 | $406.6K |
| 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… | 30 | $790 | $24.4K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 110 | $190 | $20K |
| 67950 | Canthoplasty (median or lateral) is often referred to as a corner eye lift or eye tendon surgery. The ophthalmologist uses this technique to strengthen the lateral canthal tendon or orbicularis… | 30 | $510 | $15.2K |
| 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… | 30 | $420 | $13K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 CPT/HCPCS codes.
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… | 3,330 | $290 | $968.2K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 100 | $120 | $12.2K |
| 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… | 800 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 800 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Maine providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Maine 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… | 1 | 30 | 220 | $280 | $186.7K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 2 | 10 | 100 | $80 | $21.8K |
| 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 | 10 | 270 | $1 | $1 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 3 | 10 | 260 | $0 | $0 |
Other providers in the same ZIP code as Maine Eye Care Associates, ranked by combined Medicare and Medicaid revenue.
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