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NPI 1255911970 · Covington, LA · Ambulatory Surgical Clinic/Center
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Pinnacle Surgery Center is a ambulatory surgical clinic/center provider located in Covington, Louisiana. This profile covers 18 Medicare and 2 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 | Pinnacle Surgery Center |
| Address | 1234 Pinnacle Pkwy |
| City | Covington |
| State | LA |
| ZIP | 70433 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | April 8, 2021 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.4M |
| Medicaid | $0 |
This provider’s Medicare footprint is modest in absolute scale but concentrated: lifetime Medicare revenue is $1.4M while Medicaid revenue is $0, so the practice is effectively single‑payer (Medicare) in the dataset. The NPI was enumerated on 2021-04-08 (~5 years ago), indicating a relatively recent enrollment date for the Medicare program.
Revenue is heavily concentrated in a very small set of services: the precomputed top 3 Medicare codes account for 57.6% of this provider’s total Medicare revenue. The three leading codes are 63685 ($373.8K, 25.9%), 63650 ($240.3K, 16.6%), and 66984 ($217.9K, 15.1%), showing that a few procedures generate the majority of billed Medicare dollars.
Clinical mix and service lines point to a spine/interventional pain and ambulatory surgical practice: high‑value implant and neurostimulation codes such as 63685 (spinal neurostimulator pulse generator insertion), 63650 (epidural electrode placement), and 64555 (peripheral nerve neurostimulator implantation) dominate revenue, supported by frequent image‑guided pain procedures like 64635 and 64633. This combination of device implants and repeat interventional pain services is consistent with an ambulatory surgical clinic that maintains both operating room and pain‑procedure capability.
There is also a meaningful ophthalmology component: 66984 (cataract extraction with intraocular lens) accounts for 283 claims and $217.9K (15.1% of Medicare revenue), and eyelid repair codes such as 67904 and 67924 appear in the top 25. The presence of high‑volume cataract work alongside spine and pain procedures suggests either multi‑specialty use of the ASC or shared OR time enabling both ophthalmic and spine interventions.
Competitive standing is mixed across specific services. Neurostimulator implantation and epidural electrode placement (63685 and 63650) both sit in the 70th–75th percentile nationally and are described as “typical, unremarkable volume,” indicating a modest but not dominant national presence for those implant procedures, while cataract surgery (66984) is also at the 74th percentile and similarly typical in scale.
However, the practice shows above‑typical national activity for certain image‑guided denervation procedures: 64633 ranks in the 95th percentile and is labeled “notably above typical national volume,” and 64635 is in the 91st percentile. These high percentiles identify a clear strength in facet‑joint neurolytic/denervation services relative to national peers and may be a distinctive operational emphasis compared with other ASCs.
Conversely, several major fusion codes register low relative activity: 27279 (SI joint fusion) and 22612 (lumbar fusion) each rank in the 8th percentile nationally and are described as “typical, unremarkable volume” at that percentile level, which here denotes lower activity versus peers. This divergence—high activity in minimally invasive denervation and neuromodulation alongside low activity in open fusion procedures—suggests the center prioritizes less invasive spine interventions and device implantation over large open fusion cases.
Payer and revenue implications: high average paid amounts on select implant codes amplify revenue concentration even with modest claim counts—63685 has an $16254 avg paid/claim and 27279 has a $12124 avg paid/claim—which helps explain how a limited set of CPTs can produce 57.6% of Medicare revenue. For payers and analysts, this profile signals sensitivity to reimbursement policy changes affecting device implants and image‑guided denervation codes, while the absence of Medicaid revenue means any policy or network changes affecting Medicare will disproportionately impact the provider’s overall revenue base.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
18 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 63685 | The provider inserts or replaces a spinal neurostimulator pulse generator or receiver. The system is one that requires surgical creation of a pocket for placement and that requires a connection… | 20 | $16,250 | $373.8K |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 70 | $3,480 | $240.3K |
| 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… | 280 | $770 | $217.9K |
| 27279 | The provider performs sacroiliac (SI) joint fusion using a percutaneous or minimally invasive approach. The SI joint is where the sacrum (the base of the spine) meets the ilium (part of the pelvic… | 10 | $12,120 | $145.5K |
| 22612 | The provider performs arthrodesis, also known as spinal fusion, in the lumbar spine (lower back), to permanently join two vertebrae, the interlocking bones of the spine. The provider applies bone… | 10 | $11,280 | $135.4K |
| 64555 | A neurostimulator includes electrodes which are inserted under the skin and induced by a generator to stimulate the nerve tissue. Use of this stimulator involves implantation of electrodes around a… | 30 | $3,970 | $107.2K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 120 | $470 | $56.6K |
| 64633 | In this procedure, the provider destroys the facet joint nerve of a cervical or thoracic spinal segment using neurolytic agents like heat, electric current, or a chemical compound. He makes use of… | 80 | $450 | $36.1K |
| 64493 | The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance… | 100 | $240 | $23.2K |
| 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… | 40 | $480 | $21K |
Showing 1–10 of 18
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 18 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
18 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 63685 | 5 | 20 | 20 | $7,420 | $141K |
| 63650 | 7 | 20 | 50 | $1,670 | $91.8K |
| 66984 | 39 | 210 | 80 | $500 | $91.3K |
| 27279 | 1 | 10 | 10 | $6,270 | $75.2K |
| 64555 | 2 | 10 | 30 | $1,230 | $29.5K |
| 15260 | 10 | 20 | 20 | $700 | $27.3K |
| 22612 | 28 | 30 | 20 | $930 | $25.1K |
| 64635 | 18 | 120 | 40 | $340 | $23.5K |
| 64483 | 59 | 140 | 60 | $170 | $20.2K |
| 64493 | 34 | 120 | 50 | $170 | $15.4K |
Showing 1–10 of 18
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.
2 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 60 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Louisiana providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Louisiana median
2 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 42 | 50 | 320 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 26 | 40 | 190 | $0 | $0 |
Other providers in the same ZIP code as Pinnacle Surgery Center, ranked by combined Medicare and Medicaid revenue.
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