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NPI 1083796221 · Bloomington, IN · Ambulatory Surgical Clinic/Center
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Southern Indiana Surgery Center, LLC is a ambulatory surgical clinic/center provider located in Bloomington, Indiana. This profile covers 17 Medicare and 5 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 | Southern Indiana Surgery Center, LLC |
| Address | 2800 Rex Grossman Blvd |
| City | Bloomington |
| State | IN |
| ZIP | 47403 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | October 19, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.4M |
| Medicaid | $516.1K |
This facility is an ambulatory surgical clinic/center whose Medicare revenue is highly concentrated in major joint arthroplasty: 27447 (knee replacement) and 27130 (hip replacement) together drive the bulk of Medicare receipts, with 27447 reporting $733.6K (51.3% of Medicare revenue) and 27130 $438K (30.6% of Medicare revenue). The precomputed top-3 Medicare codes account for 85.3% of the provider's total Medicare revenue, signaling the ASC operates with a clear orthopedic joint-replacement service-line focus alongside a smaller set of ancillary procedures.
Medicaid billing is effectively dominated by pediatric/ENT procedures: 69436 (tympanostomy) is the primary Medicaid revenue source at $481K (93.3% of this provider's total Medicaid revenue), and the precomputed top-3 Medicaid codes account for 100.0% of Medicaid revenue. This indicates the center also runs a high-volume tympanostomy/ENT practice for Medicaid patients, with smaller contributions from 42820 (tonsil/adenoid, $21.2K) and 41899 (dental/adjoining procedures, $13.4K).
Payer mix shows Medicare scale is larger than Medicaid in absolute dollars: the provider reports $1.4M in total Medicare revenue versus $516.1K in total Medicaid revenue, so Medicare is the dominant single commercial payer source on file while Medicaid remains a meaningful but smaller payer. These figures reflect a dual-payer operation with different service emphasis across payers (orthopedics on Medicare, ENT/pediatric procedures on Medicaid).
Competitive standing for Medicare joint replacement is strong: 27447 ranks #817 of 12,089 providers nationally (93rd percentile) and 27130 ranks #991 of 8,062 providers (87th percentile), which the source labels as notably above typical national volume for 27447 and unremarkable for 27130 respectively. The facility also shows elevated national positioning on select ENT endoscopic codes (31267 ranks #20 of 389, 94th percentile, labeled notably above typical), suggesting it is a national outlier in a narrow set of procedures rather than a broad high-volume multispecialty center.
There is a marked statistical outlier in Medicare tympanostomy activity: 69436 is reported as an extreme outlier nationally (rank #1 of 120 providers, 100th percentile, far above typical national volume) despite the same code being a more typical high-volume Medicaid service locally (Medicaid rank #7 of 58 in-state, 89th percentile). This pattern implies very concentrated tympanostomy billing that is unusually high on Medicare relative to national peers while remaining strong but not singular within the state Medicaid market.
Medicaid billing records include several codes with non-revenue claims: C1889 (78 claims, $0 avg paid/claim) and G8907 (56 claims, $0 avg paid/claim) appear on the ledger with counts but no associated paid revenue. These zero-dollar line items are present in the Medicaid dataset and should be considered when reconciling claim counts versus paid-dollar totals or when analyzing ancillary device/quality-reporting claim activity.
The provider’s Medicare CPT mix beyond joint replacement includes a meaningful slate of ENT and hand procedures (e.g., 31267 endoscopic maxillary sinus surgery $47.5K, 30140 inferior turbinate resection $31.1K, 64721 carpal tunnel release $31K), which indicates multi-specialty procedural capability within the ambulatory-surgery setting. This combination of orthopedics, otolaryngology, and minor hand surgery supports an ASC business model that accommodates both higher-reimbursement implant cases and volume-driven outpatient procedures.
The NPI was enumerated on 2006-10-19 (~20 years ago), indicating long-standing enrollment and an established operating history; tenure combined with concentrated high-volume codes may reflect an established regional referral pipeline for joint arthroplasty and pediatric ENT services. This longevity supports interpretation of the observed revenue concentration as an operational specialization rather than a short-term anomaly.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
17 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 27447 | In this procedure, the provider replaces the damaged weight bearing surfaces of both the medial and lateral compartments in the knee joint using implants of metal or other strong materials. The… | 110 | $6,990 | $733.6K |
| 27130 | In this procedure, the provider surgically replaces the hip joint by prosthesis, or artificial hip joint. He replaces both the femoral and acetabular components with or without using an autograft or… | 60 | $7,180 | $438K |
| 31267 | In this procedure, the provider inserts an endoscope into the nasal cavity. She then gains access to the maxillary sinus through a cut in the uncinate process. The provider opens the maxillary sinus… | 50 | $1,060 | $47.5K |
| 30140 | This CPT code is for a submucous resection of the inferior turbinate (partial or complete by any method). | 70 | $430 | $31.1K |
| 64721 | Neuroplasty or transposition of the median nerve at the carpal tunnel is done to treat a condition called carpal tunnel syndrome (CTS). The carpal tunnel is a narrow tunnel in the wrist through which… | 50 | $600 | $31K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 90 | $330 | $29.2K |
| 31276 | In this procedure, the provider inserts an endoscope into the frontal sinus to explore it for abnormalities. The provider may also remove bone, scar tissue, polyps, or other tissue from the frontal… | 20 | $1,180 | $24.7K |
| 26055 | Trigger finger, or stenosing tenosynovitis, is when a finger remains in a bent position. It is painful to open or close the finger. A swollen tendon or formation of knots or nodules in the tendon may… | 50 | $460 | $22.1K |
| 30520 | Septoplasty is most often performed for a deviated septum which can be either C–shaped, S–shaped, or a cartilaginous deviation. | 40 | $550 | $20.8K |
| 52356 | The provider performs a cystourethroscopy, the inspection of the interior of the bladder, the urethra, prostatic urethra, and ureteric openings using a cystoscope passed through the urethra and into… | 10 | $1,690 | $20.3K |
Showing 1–10 of 17
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 17 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
17 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 27447 | 19 | 340 | 40 | $1,130 | $51.1K |
| 27130 | 20 | 220 | 30 | $1,280 | $40.9K |
| 64721 | 24 | 100 | 30 | $420 | $16.2K |
| 31267 | 1 | 10 | 10 | $690 | $12.5K |
| 52356 | 91 | 100 | 20 | $520 | $12K |
| 25447 | 14 | 20 | 20 | $620 | $11.2K |
| 26055 | 21 | 90 | 30 | $280 | $10.5K |
| 31276 | 2 | 10 | 10 | $540 | $8.7K |
| 30520 | 1 | 20 | 20 | $480 | $8.1K |
| 64718 | 9 | 30 | 20 | $390 | $7.4K |
Showing 1–10 of 17
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.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 1,120 | $430 | $481K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 30 | $620 | $21.2K |
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 30 | $520 | $13.4K |
| C1889 | Implantable/insertable device, not otherwise classified | 80 | $0 | $0 |
| 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… | 60 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Indiana providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Indiana median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 30 | 30 | 450 | $1,270 | $886.9K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 20 | 30 | 60 | $840 | $335.8K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 7 | 60 | 150 | $480 | $221.3K |
| C1889 | Implantable/insertable device, not otherwise classified | 2 | 10 | 30 | $0 | $0 |
| 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… | 54 | 70 | 320 | $0 | $0 |
Other providers in the same ZIP code as Southern Indiana Surgery Center, LLC, ranked by combined Medicare and Medicaid revenue.
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