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NPI 1154314409 · Lexington, SC · Ambulance
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Lexington County Ems is a ambulance provider located in Lexington, South Carolina. 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 | Lexington County Ems |
| Address | 5005 Sunset Blvd |
| City | Lexington |
| State | SC |
| ZIP | 29072 |
| Taxonomy | Ambulance |
| NPI Enumerated | August 23, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $6.9M |
| Medicare | $2.9M |
LEXINGTON COUNTY EMS bills materially more to Medicaid than to Medicare, with Total Medicare revenue: $2.9M versus Total Medicaid revenue: $6.9M, indicating Medicaid is the larger payer relationship on file for this provider. Both payers are active in the dataset, so the provider is not single‑payer, but Medicaid accounts for the majority of documented lifetime revenue.
The provider’s service mix is concentrated in ground ambulance emergency transport: the top revenue-driving codes across payers are A0429 (BLS emergency transport), A0427 (ALS1 emergency transport) and A0425 (ground mileage). These codes describe routine emergency ground transports with basic and advanced life support plus per-mile billing, consistent with an operational focus on frequent emergency ambulance responses rather than non‑emergency or ancillary services.
Medicare revenue is highly concentrated: the precomputed top-3 Medicare codes account for 98.8% of this provider's Total Medicare revenue. The Medicare portfolio is dominated by A0429 (4.4K claims, $314 avg paid/claim, $1.4M revenue; 46.6% of this provider's total Medicare revenue), A0427 (2.6K claims, $373 avg paid/claim, $971.7K revenue; 33.0%) and A0425 (81.1K claims, $7 avg paid/claim, $567.5K revenue; 19.3%), which together show a narrow revenue base concentrated in emergency ground transport and mileage.
Medicaid revenue shows a similar concentration pattern, with the top-3 Medicaid codes accounting for 97.7% of this provider's Total Medicaid revenue. A0429 drives the largest share of Medicaid revenue (44.9K claims, $86 avg paid/claim, $3.9M revenue; 55.5% of this provider's total Medicaid revenue), followed by A0427 (19K claims, $88 avg paid/claim, $1.7M revenue; 24.0%) and A0425 (63.3K claims, $20 avg paid/claim, $1.3M revenue; 18.2%), reinforcing that emergency transport and mileage are the primary business lines for Medicaid as well.
On competitive standing, LEXINGTON COUNTY EMS is a major outlier for BLS emergency transport: A0429 ranks #62 of 7808 nationally for Medicare (99th percentile; extreme outlier) and ranks #2 of 85 in-state for Medicaid (99th percentile; extreme outlier), indicating unusually high volume on this code relative to peers. Ground mileage A0425 also shows notably elevated volume (Medicare rank #212 of 8934, 98th percentile; Medicaid rank #4 of 108, 97th percentile), which together suggest market dominance in frequent, long-running ground transports within its service area.
Operational volume indicators point to very high utilization: the provider reported 81.1K Medicare claims for A0425 (ground mileage) and 63.3K Medicaid claims for A0425, alongside 44.9K Medicaid claims for A0429. Those claim counts, paired with the revenue shares above, imply a high-frequency ambulance operation that bills extensively for both transport units and per‑mile charges rather than a diversified set of ancillary services.
Some code-level nuances are notable for analysts reviewing utilization mix: Medicare A0427 (ALS1) appears with 2.6K claims and ranks #263 of 6841 nationally (96th percentile) but is described as typical/unremarkable volume for that code, while the same A0427 under Medicaid shows higher relative state standing (19K claims, rank #8 of 90, 92nd percentile; notably above typical). The presence of both BLS and ALS emergency transport at scale suggests the service line routinely responds across acuity levels, with Medicaid volumes disproportionately larger.
The provider has an established presence in national billing datasets, with NPI enumerated 2005-08-23 (~21 years ago), and its code mix is consistent across payers: the same three codes dominate Medicare and Medicaid revenue (precomputed top-3 shares 98.8% for Medicare and 97.7% for Medicaid). That long tenure plus a concentrated, high-volume transport profile indicates a stable, specialized ambulance operator with entrenched emergency transport activity in its 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 |
|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 4,380 | $310 | $1.4M |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 2,610 | $370 | $971.7K |
| A0425 | Ground mileage, per statute mile | 81,080 | $10 | $567.5K |
| A0433 | Advanced life support, level 2 (als 2) | 60 | $520 | $29.9K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 40 | $110 | $4.3K |
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 |
|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 44,860 | $90 | $3.9M |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 19,000 | $90 | $1.7M |
| A0425 | Ground mileage, per statute mile | 63,270 | $20 | $1.3M |
| A0998 | Ambulance response and treatment, no transport | 5,060 | $30 | $162K |
How this provider's Medicaid billing volume and revenue compare to other South Carolina providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. South Carolina median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 2 | 90 | 1,720 | $90 | $577.3K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 8 | 90 | 1,720 | $110 | $525.8K |
| A0425 | Ground mileage, per statute mile | 4 | 110 | 3,520 | $20 | $193.8K |
| A0998 | Ambulance response and treatment, no transport | 5 | 30 | 1,200 | $30 | $85.5K |
Other providers in the same ZIP code as Lexington County Ems, ranked by combined Medicare and Medicaid revenue.
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