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NPI 1154945921 · Missoula, MT · Ambulatory Surgical Clinic/Center
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Montana Endoscopy Center, PLLC is a ambulatory surgical clinic/center provider located in Missoula, Montana. This profile covers 10 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 | Montana Endoscopy Center, PLLC |
| Address | 1930 W Broadway |
| City | Missoula |
| State | MT |
| ZIP | 59808 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | June 8, 2020 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $675.2K |
| Medicaid | $391.3K |
The provider operates as an ambulatory surgical clinic/center focused on GI endoscopy: Medicare and Medicaid revenue is dominated by colonoscopy- and endoscopy-related procedures. On Medicare the top revenue drivers are 45380 ($236.7K), 45385 ($215.1K) and 43239 ($74.2K); on Medicaid the top drivers are 45380 ($191.2K), 43239 ($103.4K) and 45385 ($82K), which together reflect a service mix concentrated in diagnostic and therapeutic colonoscopies and upper endoscopic biopsies.
Revenue concentration is high across both payers: the top 3 Medicare codes by revenue account for 77.9% of total Medicare revenue, while the top 3 Medicaid codes account for 96.2% of total Medicaid revenue. This indicates most billing activity and financial performance is driven by a small set of endoscopy procedures rather than a broader procedural portfolio.
The practice has meaningful scale with lifetime Medicare revenue of $675.2K and Medicaid revenue of $391.3K, so Medicare represents the larger single payer but the center is not single-payer dependent. Both payers contribute materially to overall volume and should be considered when evaluating utilization and contract negotiations.
Against national Medicare peers this facility is an outsized performer for key colonoscopy codes: 45380 ranks #98 of 16427 providers (99th percentile; extreme outlier) and 45385 ranks #277 of 16310 providers (98th percentile; extreme outlier), while 43239 ranks #674 of 17140 providers (96th percentile; notably above typical national volume). Those national positions indicate the center produces substantially higher Medicare volumes for these specific endoscopy services than typical U.S. ambulatory centers.
By contrast, in-state Medicaid rankings are much more ordinary: 45380 is #6 of 24 providers in-state (78th percentile; typical, unremarkable volume), 43239 is #16 of 29 (46th percentile; typical, unremarkable volume), and 45385 is #9 of 20 (58th percentile; typical, unremarkable volume). This suggests the provider’s Medicare dominance is not mirrored in Medicaid, where it is a modest participant among Montana endoscopy providers.
The provider’s code mix shows both therapeutic/diagnostic procedures and screening volumes: Medicare screening code G0121 contributes $50.8K (7.5% of Medicare revenue) and G0105 contributes $17.9K (2.7%), indicating screening colonoscopies form a secondary but meaningful portion of outpatient throughput alongside polypectomy and biopsy work. Operational planning and staffing should reflect this blend of screening, diagnostic, and therapeutic cases.
Operational tenure is moderate: the NPI was enumerated 2020-06-08 (~6 years ago), which corresponds to several years of established billing history but a relatively recent market entry compared with long-standing competitors. Given the concentrated code set driving most revenue, new payor arrangements or changes in colonoscopy referral patterns could materially affect financial performance.
Multiple procedure-level labels point to distinct statistical behavior across payers: for Medicare the facility is an "extreme outlier" on 45380 and 45385 and "notably above typical" on 43239, while for Medicaid the same codes are described as "typical, unremarkable volume" in-state. Analysts should treat national Medicare volumes as exceptional while approaching Medicaid comparisons with the expectation of routine in-state competitiveness.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 45380 | The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include… | 710 | $330 | $236.7K |
| 45385 | The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a… | 540 | $400 | $215.1K |
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 320 | $230 | $74.2K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 130 | $410 | $50.8K |
| 43249 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum and dilates (widens) the esophagus with a balloon less than 30 mm in diameter. | 70 | $550 | $39.9K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 40 | $410 | $17.9K |
| 43235 | The provider inserts an endoscope through the mouth and down into the esophagus, stomach, and duodenum for diagnostic purposes; the provider may collect specimens by brushing or washing. | 60 | $280 | $17.4K |
| 45381 | The provider inserts a flexible endoscope into the anus and navigates the scope through the entire colon. The provider performs one or more injections into the submucosa (the tissue below the mucous… | 50 | $220 | $11.5K |
| 45378 | The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush… | 30 | $290 | $8.4K |
| 45382 | The provider examines the colon and rectum using a colonoscope, a tubular instrument with a light source and camera, to identify the source of internal bleeding. He then controls the bleeding in the… | 20 | $190 | $3.1K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 10 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
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 |
|---|---|---|---|---|
| 45380 | The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include… | 530 | $360 | $191.2K |
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 400 | $260 | $103.4K |
| 45385 | The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a… | 210 | $400 | $82K |
| 45378 | The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush… | 40 | $370 | $14.7K |
How this provider's Medicaid billing volume and revenue compare to other Montana providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Montana median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 43239 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum where he removes one or more tissue biopsy specimens for diagnostic analysis. | 16 | 30 | 470 | $80 | $64.1K |
| 45380 | The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient's symptoms, which may include… | 6 | 20 | 120 | $70 | $24.9K |
| 45385 | The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a… | 9 | 20 | 130 | $40 | $10K |
| 45378 | The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush… | 4 | 10 | 30 | $40 | $2.4K |
Other providers in the same ZIP code as Montana Endoscopy Center, PLLC, ranked by combined Medicare and Medicaid revenue.
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