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NPI 1295755023 · Madison, WI · Ambulatory Surgical Clinic/Center
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Madison Surgery Center, Inc. is a ambulatory surgical clinic/center provider located in Madison, Wisconsin. This profile covers 31 Medicare and 8 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 | Madison Surgery Center, Inc. |
| Address | 1 S Park St |
| City | Madison |
| State | WI |
| ZIP | 53715 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | July 21, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.6M |
| Medicaid | $549.2K |
MADISON SURGERY CENTER operates as an Ambulatory Surgical Clinic/Center with a dual clinical focus: ophthalmic surgery and interventional pain/spine procedures. The Medicare and Medicaid claims mix is dominated by cataract extraction and intraocular lens insertion codes (66984, 66982) alongside a cluster of high-volume epidural/facet and nerve procedures (64483, 64493, 63650, 64635), indicating the center provides both eye surgery services and image-guided pain interventions in an ASC setting.
Revenue concentration differs by payer: for Medicare the precomputed top-3 codes account for 59.1% of total Medicare revenue, driven largely by 66984 (43.5%), 64555 (8.9%), and 66982 (6.6%). For Medicaid the concentration is far more acute, with the precomputed top-3 codes accounting for 95.3% of total Medicaid revenue, specifically 66984 (43.6%), 64493 (27.4%), and 64483 (24.3%).
Medicare is the dominant payer by scale for this provider: the file shows Total Medicare revenue of $3.6M versus Total Medicaid revenue of $549.2K, so Medicare represents the primary revenue stream while Medicaid is a much smaller share of business. This makes the center effectively Medicare-led in overall financial scale rather than single-payer dependent.
National competitive standing on Medicare is mixed but includes notable high-volume signals for interventional services: 66982 ranks #50 of 4580 providers (99th percentile; notably above typical national volume) and 64483 ranks #114 of 8202 providers (99th percentile; extreme outlier, far above typical national volume), while 66984 ranks #1178 of 15965 (93th percentile; typical, unremarkable volume for this code). These ranks suggest the center is a national high-volume outlier for several image-guided pain and some complex cataract procedures, even if routine cataract work sits at typical national volume.
State-level (Medicaid) competitive standing emphasizes the center's strength in pain injections: 64493 ranks #6 of 57 providers in-state (91th percentile) and 64483 ranks #7 of 55 (89th percentile), indicating a strong in-state footprint for these services, whereas the Medicaid volume for 66984 (rank #12 of 33, 66th percentile) is more typical compared with in-state peers. This pattern implies local market leadership in interventional spine services within Wisconsin Medicaid populations.
Multiple codes are flagged as extreme outliers or notably above typical national volume, creating a clear specialty signal and potential utilization focus: on Medicare, 64483 and 64493 are labeled "extreme outlier, far above typical national volume," 66982 is "notably above typical national volume," and additional pain codes (e.g., 64454, 64635, 26055) are at very high percentiles. These labels point to a concentrated operational specialization in interventional pain management that will drive payer contracting and utilization review attention.
Tenure and stability: the NPI was enumerated on 2006-07-21 (~20 years ago), indicating an established ambulatory surgery presence in Madison. That length of activity supports the inference of a mature ASC with an entrenched procedural mix rather than a recently diversified practice.
Revenue composition includes several high-dollar-per-claim services that materially contribute despite lower claim counts: for example, Medicare shows 64555 with an average paid/claim of $4515 and V2785 with $5136 avg paid/claim, while high-volume, lower-paid injection codes (e.g., 64493 at $271 avg on Medicare and $103 avg on Medicaid) generate substantial aggregate revenue through volume. Payers and analysts should note the mix of implant/high-unit-value items and high-frequency image-guided injections when assessing reimbursement risk and negotiating bundles or ASC rates.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
31 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… | 1,800 | $870 | $1.6M |
| 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… | 70 | $4,520 | $320.6K |
| 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… | 280 | $870 | $238.2K |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 50 | $3,960 | $210.1K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 610 | $310 | $185.7K |
| V2785 | Processing, preserving and transporting corneal tissue | 30 | $5,140 | $159.2K |
| 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… | 540 | $270 | $145.8K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 210 | $540 | $113.5K |
| 65820 | The provider incises the limbus to improve drainage of aqueous humor in the eye. This procedure is typically performed on children, usually to treat congenital glaucoma. | 50 | $1,570 | $72.3K |
| 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… | 140 | $500 | $70.4K |
Showing 1–10 of 31
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 31 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
31 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 63650 | 9 | 20 | 50 | $1,720 | $86.2K |
| V2785 | 1 | 10 | 20 | $3,940 | $78.7K |
| 64555 | 1 | 10 | 30 | $2,050 | $73.9K |
| 66984 | 94 | 310 | 350 | $50 | $66.4K |
| 65820 | 3 | 20 | 20 | $870 | $25.2K |
| 66982 | 3 | 80 | 20 | $490 | $21.7K |
| 65756 | 2 | 10 | 20 | $1,030 | $21.7K |
| 15823 | 16 | 30 | 30 | $540 | $19.4K |
| G0260 | 1 | 20 | 50 | $210 | $16.8K |
| 29848 | 1 | 10 | 30 | $410 | $14.2K |
Showing 1–10 of 31
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.
8 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… | 590 | $410 | $240.1K |
| 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… | 1,460 | $100 | $150.5K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 1,050 | $130 | $133.6K |
| 62323 | The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)… | 100 | $120 | $11.3K |
| 64494 | In this add–on procedure, 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… | 350 | $20 | $8.1K |
| 27096 | The provider performs an injection in the joint between the sacrum and ilium on one side of the body, with the aid of imaging equipment to locate the injection site. He injects an anesthetic to… | 40 | $150 | $6.5K |
| 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… | 1,920 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 1,780 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Wisconsin providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Wisconsin median
8 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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… | 12 | 30 | 210 | $310 | $207.3K |
| 27096 | The provider performs an injection in the joint between the sacrum and ilium on one side of the body, with the aid of imaging equipment to locate the injection site. He injects an anesthetic to… | 13 | 20 | 230 | $140 | $69.6K |
| 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… | 6 | 60 | 80 | $130 | $60.6K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 7 | 60 | 140 | $130 | $51.8K |
| 62323 | The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)… | 29 | 50 | 120 | $110 | $34.3K |
| 64494 | In this add–on procedure, 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… | 12 | 50 | 80 | $50 | $23.2K |
| 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… | 5 | 40 | 130 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 4 | 20 | 220 | $0 | $0 |
Other providers in the same ZIP code as Madison Surgery Center, Inc., ranked by combined Medicare and Medicaid revenue.
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