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NPI 1215931134 · Corbin, KY · Ambulatory Surgical Clinic/Center
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Cumberland Valley Surgical Center, LLC is a ambulatory surgical clinic/center provider located in Corbin, Kentucky. This profile covers 14 Medicare and 13 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 | Cumberland Valley Surgical Center, LLC |
| Address | 275 Highway 770 |
| City | Corbin |
| State | KY |
| ZIP | 40701 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | June 9, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $5.2M |
| Medicare | $1M |
CUMBERLAND VALLEY SURGICAL CENTER is structured and billed like a mixed ophthalmology and endoscopy ambulatory surgical center: its highest-revenue codes across both payers are ophthalmic (66984, 66982, 66821, 67904) and gastrointestinal endoscopy (45385, 45380, 43239). On Medicare, 66984 alone generates $620.9K (59.4% of the provider's total Medicare revenue) and on Medicaid 66984 produces $2.4M (46.4% of the provider's total Medicaid revenue), signaling a clinical focus on cataract surgery with substantial ancillary eye procedures and routine endoscopy throughput. The presence of codes such as 41899 on Medicaid ($1M, 19.2%) also indicates the facility bills for dental/adjoining-procedure work or similarly coded services alongside its surgical mix.
Revenue is highly concentrated by a few CPT/HCPCS lines: the provider's top three Medicare codes account for 74.6% of its total Medicare revenue, and the top three Medicaid codes account for 77.1% of its total Medicaid revenue. That concentration means financial performance is sensitive to volume and reimbursement changes in a small set of procedures—primarily cataract-related services and a couple of high-volume endoscopy codes—rather than a broad, diversified case mix.
Payer mix is dominated by Medicaid volume and dollars: total Medicaid revenue is $5.2M versus total Medicare revenue of $1M, so the facility operates with a Medicaid-led revenue base. In operational terms, this suggests the business and capacity planning, staffing, and payer negotiations will be particularly impacted by Medicaid utilization patterns and state-level reimbursement.
Nationally on Medicare the provider posts solid but not top-tier volumes for its leading codes: 66984 ranks #2209 of 15965 providers nationally (86th percentile; typical, unremarkable volume for this code), 45385 ranks #1457 of 16310 (91th percentile; typical, unremarkable volume), and 66982 ranks #334 of 4580 (93th percentile; typical, unremarkable volume). Those placements indicate the center is a credible, mid-to-higher volume national participant for common cataract and endoscopy services but is not a national outlier or dominant system-level operator for Medicare.
By contrast the provider is a dominant state-level player for several Medicaid ophthalmology codes: 66984 ranks #1 of 71 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code) and 66821 ranks #1 of 8 providers in-state (100th percentile; notably above typical state volume for this code). This statewide outlier status on Medicaid for cataract and related laser capsulotomy procedures signals market leadership in Kentucky Medicaid for ambulatory ophthalmic surgery.
Medicaid claim volumes underline the throughput-driven nature of the center: 66984 reports 6.3K claims ($386 avg paid/claim, $2.4M revenue), 43239 has 3.3K claims ($182 avg paid/claim, $600.8K revenue), and 41899 has 1.6K claims ($618 avg paid/claim, $1M revenue). Those claim counts—especially the 6.3K for 66984—point to high procedural throughput and capacity for ambulatory cataract and endoscopic cases relative to in-state peers, and they help explain the Medicaid revenue dominance.
The facility has an established presence with an NPI enumerated on 2005-06-09 (~21 years ago), suggesting long-term operation in the local market and the opportunity to have built referral relationships and procedural volume over time. Tenure combined with the Medicaid dominance implies entrenched local positioning for the procedures that drive most revenue.
A few billing nuances are visible in the data: Medicaid includes uncommon or catch-all lines such as 41899 ($1M, 19.2% of Medicaid revenue) and procedure-quality reporting codes G8907 and G8918 with $0 avg paid/claim and $0 revenue. The sizable share of 41899 suggests facility billing for dental or procedure types without a specific code, and the $0-revenue quality/process codes reflect routine reporting rather than direct reimbursement impact; both points are important to review for coding mix and contract negotiations.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
14 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… | 820 | $760 | $620.9K |
| 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… | 190 | $410 | $80.1K |
| 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… | 100 | $770 | $78.9K |
| 66991 | The provider inserts an intraocular lens prosthesis during the same session as extracapsular cataract extraction. The provider also inserts one or more anterior segment aqueous drainage devices in… | 30 | $2,300 | $62K |
| 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. | 170 | $230 | $39K |
| 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… | 120 | $310 | $37K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 180 | $190 | $34K |
| 45384 | The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions using hot biopsy… | 50 | $420 | $20.9K |
| 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 | $490 | $16.5K |
| 66174 | The provider expands the aqueous outflow (drainage) canal of the eye to help relieve pressure in the eye. The procedure does not include leaving a device or stent in place. | 20 | $720 | $15.9K |
Showing 1–10 of 14
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 14 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
14 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 66984 | 192 | 310 | 1,560 | $40 | $67.1K |
| 66991 | 6 | 10 | 30 | $1,390 | $43K |
| 67904 | 8 | 10 | 40 | $690 | $38.5K |
| 66982 | 11 | 70 | 30 | $270 | $20.8K |
| 45385 | 19 | 250 | 50 | $250 | $20.2K |
| 66174 | 6 | 10 | 20 | $670 | $18.7K |
| 66821 | 23 | 160 | 50 | $110 | $16.1K |
| 67917 | 8 | 10 | 40 | $300 | $10.5K |
| 45380 | 34 | 240 | 40 | $140 | $9.4K |
| G0105 | 99 | 140 | 30 | $230 | $9.3K |
Showing 1–10 of 14
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.
13 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… | 6,270 | $390 | $2.4M |
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 1,620 | $620 | $1M |
| 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. | 3,300 | $180 | $600.8K |
| 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… | 1,490 | $200 | $303.8K |
| 47563 | The provider removes the gallbladder through a laparoscope, a tubular instrument with a light source and camera inserted through the abdominal wall, to treat gallbladder disease. She injects dye and… | 270 | $860 | $231.9K |
| 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… | 880 | $220 | $189.2K |
| 45384 | The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions using hot biopsy… | 1,020 | $180 | $182.9K |
| 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… | 360 | $370 | $134.3K |
| D0150 | Comprehensive oral evaluation – new or established patient | 220 | $340 | $76.3K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 360 | $150 | $54K |
Showing 1–10 of 13
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky median
13 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. | 14 | 40 | 740 | $1,170 | $1.7M |
| 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. | 35 | 170 | 1,300 | $230 | $441K |
| 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 | 70 | 210 | $310 | $290K |
| 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… | 33 | 120 | 300 | $320 | $215.2K |
| 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… | 13 | 110 | 230 | $340 | $175.7K |
| 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… | 53 | 90 | 170 | $400 | $145.8K |
| 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… | 1 | 10 | 360 | $370 | $134.3K |
| 47563 | The provider removes the gallbladder through a laparoscope, a tubular instrument with a light source and camera inserted through the abdominal wall, to treat gallbladder disease. She injects dye and… | 4 | 20 | 70 | $910 | $130.7K |
| D0150 | Comprehensive oral evaluation – new or established patient | 720 | 1,010 | 740 | $30 | $61.4K |
| 45384 | The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions using hot biopsy… | 2 | 10 | 40 | $180 | $33.6K |
Showing 1–10 of 13
Other providers in the same ZIP code as Cumberland Valley Surgical Center, LLC, ranked by combined Medicare and Medicaid revenue.
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