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NPI 1124084843 · Saint Cloud, MN · Ambulatory Surgical Clinic/Center
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St Cloud Outpatient Surgery Ltd is a ambulatory surgical clinic/center provider located in Saint Cloud, Minnesota. This profile covers 26 Medicare and 12 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 | St Cloud Outpatient Surgery Ltd |
| Address | 1526 Northway Dr |
| City | Saint Cloud |
| State | MN |
| ZIP | 56303 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | April 21, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $4M |
| Medicare | $2.1M |
ST CLOUD OUTPATIENT SURGERY LTD’s Medicare case mix is driven by major joint arthroplasty and some ophthalmologic procedures, consistent with an Ambulatory Surgical Clinic/Center. The top Medicare revenue codes include 27447 (totaling $774.5K, 36.3% of Medicare revenue), 27130 ($674.6K, 31.6%), and 66984 ($133K, 6.2%), indicating the center performs substantial knee and hip replacement work alongside routine cataract extractions.
The provider’s Medicare revenue is concentrated: the top 3 Medicare codes account for 74.1% of its total Medicare revenue, out of a reported Total Medicare revenue of $2.1M. This concentration suggests that joint replacement (27447 and 27130) is the primary Medicare service line generating the majority of hospital outpatient payments.
On Medicare competitive standing, ST CLOUD ranks well above peers for large-joint procedures and is a notable national-volume center for those services. Code 27447 ranks #712 of 12089 providers nationally (94th percentile; notably above typical national volume) and 27130 ranks #264 of 8062 (97th percentile; notably above typical national volume), while other common codes like 66984 sit at a more typical volume (61st percentile). Additionally, 28285 is flagged as an extreme outlier (98th percentile), indicating unusually high volume for hammertoe repairs relative to national peers.
Medicaid billing shows a very different service mix concentrated in dental and pediatric ENT procedures, consistent with an ambulatory surgical site providing same-day pediatric and dental services. The top Medicaid codes are D2930 ($2.2M, 54.4% of Medicaid revenue), 69436 ($1.1M, 27.2%), and 42820 ($501.3K, 12.7%), reflecting dominant revenue from an unspecified dental procedure and high volumes of tympanostomy and tonsil/adenoid surgeries.
Medicaid revenue is highly concentrated in a few codes: the top 3 Medicaid codes account for 94.2% of the provider’s total Medicaid revenue, with Total Medicaid revenue reported as $4M. That degree of concentration implies the facility’s Medicaid business is focused on a narrowly defined set of procedure lines rather than a broad mix of outpatient services.
The provider is a major in-state competitor for several Medicaid surgical services, particularly pediatric ENT. In-state ranks show 69436 at #2 of 24 providers (96th percentile; notably above typical state volume) and 42820 at #1 of 12 providers (100th percentile; notably above typical state volume), while D2930 sits at #14 of 66 (80th percentile). These positions indicate the center is a leading regional site for tympanostomy and tonsil/adenoid procedures for Medicaid patients.
Payer mix is weighted toward Medicaid by scale: reported Total Medicare revenue is $2.1M versus Total Medicaid revenue of $4M, making Medicaid the larger single payer in absolute reported revenue. Combined with the distinct service-line splits (orthopedics for Medicare, dental/ENT for Medicaid), this suggests the center operates dual specialty tracks that target different patient populations by payer.
The provider’s NPI has been enumerated since 2006-04-21 (~20 years ago), indicating long tenure in the market. That longevity, paired with concentrated high-volume code ranks in both Medicare and Medicaid, is consistent with an established ambulatory surgical center that has developed sustained referral streams for its primary procedure lines.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
26 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 | $7,040 | $774.5K |
| 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… | 100 | $7,100 | $674.6K |
| 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… | 160 | $820 | $133K |
| 27446 | In this procedure, the provider reconstructs the diseased or damaged medial or lateral compartment of the knee along with the femoral condyles and tibial plateaus to relieve pain and improve the… | 20 | $6,940 | $111K |
| 28285 | The provider repairs a hammertoe deformity, a painful condition in which the toe remains permanently bent in a downward position. | 90 | $650 | $59.3K |
| 63047 | The provider performs a laminectomy (excision of the thin bony plate at the back of a vertebra), facetectomy (excision of an area of a vertebra characterized by its smooth surface), and foraminotomy… | 20 | $2,360 | $56.7K |
| 29827 | The provider examines the tissue inside the shoulder joint with an arthroscope. She inserts additional instruments to repair a torn rotator cuff, the grouping of muscles and tendons that surround and… | 20 | $1,940 | $42.7K |
| C9290 | Injection, bupivacaine liposome, 1 mg | 38,300 | $1 | $38.3K |
| 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 | $31.6K |
| 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… | 60 | $390 | $24.1K |
Showing 1–10 of 26
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 26 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
26 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J1097 | 8 | 10 | 340 | $80 | $57.9K |
| 66984 | 161 | 300 | 190 | $50 | $56K |
| 27446 | 3 | 10 | 20 | $2,280 | $52.4K |
| 27447 | 3 | 270 | 20 | $1,340 | $41.5K |
| 27130 | 2 | 190 | 20 | $1,260 | $30.3K |
| 29827 | 6 | 30 | 20 | $1,320 | $25.1K |
| C9290 | 2 | 10 | 6,650 | $1 | $18.5K |
| 28285 | 1 | 10 | 40 | $450 | $18.3K |
| 64635 | 60 | 100 | 30 | $370 | $16.2K |
| 20680 | 4 | 10 | 20 | $650 | $14.3K |
Showing 1–10 of 26
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.
12 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| D2930 | N/A | 5,570 | $390 | $2.2M |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 1,250 | $860 | $1.1M |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 460 | $1,100 | $501.3K |
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 70 | $2,150 | $159.4K |
| 42830 | The provider performs an initial adenoidectomy in a patient who is less than 12 years old. | 40 | $1,010 | $40.3K |
| D3220 | N/A | 800 | $30 | $23.3K |
| D3230 | N/A | 100 | $50 | $4.6K |
| D1120 | Prophylaxis–child | 110 | $1 | $440 |
| D7140 | Extraction, erupted tooth or exposed root (elevation and/or forceps removal) | 70 | $10 | $370 |
| D0240 | N/A | 40 | $10 | $280 |
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How this provider's Medicaid billing volume and revenue compare to other Minnesota providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Minnesota median
12 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. | 8 | 10 | 280 | $2,150 | $1M |
| D2930 | N/A | 14 | 70 | 610 | $170 | $518.6K |
| D7140 | Extraction, erupted tooth or exposed root (elevation and/or forceps removal) | 206 | 240 | 730 | $100 | $243.2K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 2 | 20 | 50 | $450 | $121.9K |
| D0240 | N/A | 51 | 50 | 510 | $30 | $95.5K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 1 | 10 | 30 | $800 | $82.4K |
| D1120 | Prophylaxis–child | 347 | 500 | 420 | $30 | $76.8K |
| D3220 | N/A | 12 | 30 | 200 | $80 | $68K |
| D0272 | N/A | 217 | 310 | 280 | $30 | $44.7K |
| 42830 | The provider performs an initial adenoidectomy in a patient who is less than 12 years old. | 2 | 10 | 30 | $490 | $15.3K |
Showing 1–10 of 12
Other providers in the same ZIP code as St Cloud Outpatient Surgery Ltd, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| St. Cloud Hospital | MN | General Acute Care Hospital | $0 | $53.4M |
| Central Minnesota Mental Health Center | MN | Mental Health Counselor | $0 | $36.2M |
| Centracare Clinic | MN | Multi-Specialty Clinic/Center | $0 | $20.8M |
| Centracare Clinic | MN | Multi-Specialty Clinic/Center | $0 | $19.3M |
| Eye Kraft Optical, Inc | MN | Eyewear Supplier | $0 | $17.7M |
| Northway Academy, Inc. | MN | Developmental Disabilities Clinic/Center | $0 | $14.4M |
| Koala Dental Care, LLC | MN | Pediatric Dentistry | $0 | $11.3M |
| Centracare Health Systems | MN | Clinical Medical Laboratory | $1.2M | $9.4M |
| Centracare Health System | MN | Clinical Medical Laboratory | $345.1K | $9.1M |
| St. Cloud Area School District 742 | MN | Local Education Agency (LEA) | $0 | $9.3M |
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