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NPI 1326119157 · Madison, WI · Ambulatory Surgical Clinic/Center
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Dean Health Systems, Inc. is a ambulatory surgical clinic/center provider located in Madison, Wisconsin. This profile covers 39 Medicare and 10 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 | Dean Health Systems, Inc. |
| Address | 700 S Park St |
| City | Madison |
| State | WI |
| ZIP | 53715 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | November 13, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2M |
| Medicaid | $856.3K |
DEAN HEALTH SYSTEMS, INC. is an ambulatory surgical clinic/center based in MADISON, WI with an NPI enumerated on 2006-11-13 (~20 years ago), indicating long-standing operation in the market. Its billing footprint spans both Medicare and Medicaid, with an established history that supports a mix of outpatient procedural services.
Medicare revenue is concentrated: total Medicare revenue is $2M and the provider's top three Medicare codes account for 49.3% of that Medicare revenue. The largest Medicare contributors are 45385 ($552.5K, 29.7% of Medicare revenue), 63685 ($219.2K, 11.8%), and 45380 ($145.4K, 7.8%), indicating dependence on a small set of high-revenue services.
Medicaid revenue is heavily concentrated in a very small set of GI/endoscopy codes: total Medicaid revenue is $856.3K and the top three Medicaid codes account for 93.1% of that Medicaid revenue. The leading Medicaid items are 43239 ($407.4K, 47.5%), 45385 ($261.2K, 30.5%), and 45380 ($129.7K, 15.1%), showing that Medicaid billing is overwhelmingly driven by upper- and lower-GI endoscopy services.
Service-line implications: the code mix shows a dominant endoscopy/colonoscopy profile with high volumes of diagnostic and therapeutic GI procedures (45385, 45380, 43239) alongside screening colonoscopy codes (G0105, G0121) on the Medicare side. This pattern is consistent with an ambulatory surgical center that prioritizes outpatient GI diagnostics and polypectomy services as a primary revenue stream.
The provider also bills a small number of very high-reimbursement implant or device procedures and interventional pain codes—most notably 63685 (11 claims, $19929 avg paid/claim, $219.2K Medicare revenue) and 64635 (239 claims, $524 avg paid/claim, $125.2K Medicare revenue). These entries suggest the clinic performs occasional high-value device implantations and a significant volume of pain-management interventions in addition to GI work.
Competitive standing varies by code and payer: for Medicare, 45385 ranks #35 of 16310 providers nationally (100th percentile; extreme outlier, far above typical national volume for this code) and 45380 ranks in the 98th percentile (extreme outlier), indicating the provider is a major national outlier in colonoscopy volume. For Medicaid, 43239 ranks #22 of 116 providers in-state (82nd percentile) and 45385 ranks #11 of 63 in-state (84th percentile), showing it is a strong regional performer for core endoscopy services but less singularly dominant than in Medicare.
Payer mix and scale: Medicare ($2M) represents the larger share of reported public-payer revenue compared with Medicaid ($856.3K), so the provider is not single-payer dependent but has a heavier Medicare footprint in absolute dollars. Medicaid remains material and is highly concentrated in the same GI service lines that dominate Medicare billing, reinforcing a consistent cross-payer clinical focus.
Operational and contracting implications: given the high concentration of revenue in a few codes (49.3% of Medicare from top three codes; 93.1% of Medicaid from top three codes) and extreme outlier status for select colonoscopy codes, payers and network managers may view the provider as a specialized endoscopy center with supplemental high-value device and pain procedures. Monitoring utilization patterns for outlier codes like 45385 and managing episode-based payment or prior-authorization strategies around high-cost implants such as 63685 could be relevant for reimbursement strategy and network placement decisions.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
39 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 1,170 | $470 | $552.5K |
| 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… | 10 | $19,930 | $219.2K |
| 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… | 430 | $340 | $145.3K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 240 | $520 | $125.2K |
| 25609 | The provider surgically repairs a fracture of the lower radius, the larger of the two lower arm bones, beyond the joint or a separation of the radius from the joint through an incision and fixes… | 30 | $3,560 | $103.2K |
| 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. | 140 | $600 | $80.9K |
| 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 | $250 | $78.1K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 170 | $430 | $72.3K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 160 | $430 | $67.7K |
| 55874 | Under imaging guidance, the provider inserts a needle through the perineum, the area between the anus and the scrotum, and injects one or more biodegradable materials, i.e., material that decomposes… | 20 | $2,800 | $50.3K |
Showing 1–10 of 39
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 39 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
39 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 63685 | 21 | 30 | 10 | $7,060 | $105.9K |
| 25609 | 1 | 10 | 20 | $2,130 | $42.6K |
| 31267 | 1 | 10 | 20 | $990 | $19.8K |
| 28285 | 7 | 10 | 20 | $390 | $19.7K |
| 58558 | 1 | 10 | 20 | $1,080 | $19.5K |
| 45385 | 1 | 320 | 60 | $230 | $16.8K |
| 14301 | 11 | 10 | 20 | $740 | $14.1K |
| 64635 | 1 | 130 | 30 | $320 | $12.3K |
| 64721 | 21 | 80 | 30 | $390 | $12.3K |
| C9290 | 4 | 10 | 5,790 | $1 | $11.5K |
Showing 1–10 of 39
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.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | 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. | 2,140 | $190 | $407.4K |
| 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… | 860 | $300 | $261.2K |
| 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… | 600 | $220 | $129.7K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 180 | $110 | $20.3K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 20 | $1,020 | $15.4K |
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 80 | $190 | $15.3K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 30 | $180 | $4.7K |
| 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… | 10 | $300 | $3.6K |
| 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… | 1,330 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 1,330 | $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
10 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. | 24 | 40 | 150 | $530 | $381.9K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 10 | 20 | 50 | $400 | $216.3K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 13 | 20 | 20 | $660 | $205.5K |
| 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. | 22 | 120 | 400 | $180 | $186.8K |
| 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… | 26 | 80 | 240 | $180 | $109.1K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 30 | 40 | 150 | $250 | $108.4K |
| 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… | 11 | 60 | 170 | $200 | $85.7K |
| 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… | 30 | 30 | 140 | $230 | $75.7K |
| 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… | 6 | 40 | 130 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 6 | 20 | 220 | $0 | $0 |
Other providers in the same ZIP code as Dean Health Systems, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Meriter Hospital, Inc. | WI | General Acute Care Hospital | $0 | $25.5M |
| Ssm Health Care Of Wisconsin, Inc. | WI | General Acute Care Hospital | $0 | $14.7M |
| Ssm Health Care Of Wisconsin, Inc | WI | Clinical Medical Laboratory | $0 | $6.4M |
| Madison Surgery Center, Inc. | WI | Ambulatory Surgical Clinic/Center | $3.6M | $549.2K |
| Ryan Bros Ambulance LLC | WI | Land Ambulance | $1.5M | $2.3M |
| Madison Emergency Physicians, Sc | WI | Emergency Medicine Physician | $0 | $3.2M |
| Emergency Medicine Associates Of Madison, Sc | WI | Emergency Medicine Physician | $0 | $2.1M |
| Meriter Health Enterprises Inc. | WI | Clinical Medical Laboratory | $680.6K | $1M |
| Michelle Lakner | WI | Nurse Practitioner | $660.9K | $0 |
| Lisa Lepeak | WI | Hematology & Oncology Physician | $488.3K | $0 |
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