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NPI 1487651956 · Crestview Hills, KY · Ambulatory Surgical Clinic/Center
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Tri-state Gastroenterology Associates, Psc is a ambulatory surgical clinic/center provider located in Crestview Hills, Kentucky. This profile covers 13 Medicare and 9 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 | Tri-state Gastroenterology Associates, Psc |
| Address | 425 Centre View Blvd |
| City | Crestview Hills |
| State | KY |
| ZIP | 41017 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | June 30, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $1.9M |
| Medicare | $940.1K |
TRI-STATE GASTROENTEROLOGY ASSOCIATES, PSC operates as an ambulatory surgical clinic/center focused on high-volume endoscopic procedures: its billed services are dominated by colonoscopy codes (45380, 45385) and upper endoscopy/biopsy (43239), and the presence of dilation codes (43248, 43450) indicates capability for therapeutic esophageal interventions as well as diagnostic biopsies. This code mix is consistent with a GI endoscopy center that provides both screening/diagnostic and advanced therapeutic procedures on an outpatient basis.
Medicare revenue is heavily concentrated in a few procedure codes: the top three Medicare codes account for 73.6% of the provider's total Medicare revenue, with 45380 contributing 30.1%, 45385 contributing 28.1%, and 43239 contributing 15.3% of Medicare revenue. That concentration signals dependence on colonoscopy and EGD biopsy services for the majority of Medicare receipts and creates revenue sensitivity to utilization or reimbursement changes for those specific codes.
Medicaid revenue is even more concentrated: the top three Medicaid codes account for 89.8% of total Medicaid revenue, led by 43239 at 40.0%, 45380 at 32.6%, and 45385 at 17.2%. This extreme concentration in a small set of endoscopy codes means the provider’s Medicaid performance is essentially a function of volume in those specific procedures.
Comparing scale across payers, the provider reports $940.1K in lifetime Medicare revenue versus $1.9M in lifetime Medicaid revenue, so Medicaid represents the larger revenue pool for this clinic. The skew toward Medicaid revenue has implications for contracting strategy and revenue sensitivity to state Medicaid policy and reimbursement rates.
On competitive standing, the clinic shows unusually high procedure volumes versus national Medicare peers: 45380 ranks #76 (100th percentile, described as an "extreme outlier"), 45385 ranks #232 (99th percentile, "extreme outlier"), and 43239 ranks #102 (99th percentile, "extreme outlier"). Those national percentiles indicate the practice is one of the highest-volume providers in the country for core colonoscopy and EGD biopsy services.
Within its state Medicaid market the practice also posts strong relative volume: 43239 ranks #19 of 174 providers in-state (90th percentile, "notably above typical"), 45380 ranks #6 of 122 (96th percentile, "notably above typical"), and 45385 ranks #18 of 105 (84th percentile, "typical, unremarkable"); additionally 43248 ranks #1 of 16 providers in-state (100th percentile, "notably above typical"). These state rankings point to local market strength—especially for esophageal dilation (43248) and screening/diagnostic colonoscopy (45380).
The provider has an established operational history (NPI enumerated 2005-06-30, ~21 years ago), which together with the very high volumes on core endoscopy codes suggests a stable referral base and sustained procedural throughput. Because several top codes are characterized as "extreme outlier" or "notably above typical," the facility likely represents significant local/endoscopy capacity and would be a logical candidate for payer network inclusion, utilization monitoring, and focused contracting discussions.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
13 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… | 770 | $370 | $283.1K |
| 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… | 600 | $440 | $264.2K |
| 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. | 750 | $190 | $144.2K |
| 43248 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum; then through the scope, he passes a guidewire over which he passes dilators through the… | 290 | $250 | $71.8K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 130 | $400 | $53.5K |
| 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. | 80 | $540 | $43.9K |
| 43450 | The provider passes long thin tubular devices of increasing diameter to dilate, or widen, a stricture in the patient’s esophagus to improve swallowing. | 100 | $250 | $23.4K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 50 | $410 | $18.8K |
| 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 | $290 | $11.2K |
| 43259 | An esophagogastroduodenoscopy is a procedure to view the esophagus, stomach, and duodenum by means of flexible endoscope through the mouth. During this procedure, the physician uses endoscopic… | 20 | $570 | $9.1K |
Showing 1–10 of 13
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 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.
9 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. | 4,970 | $150 | $765.7K |
| 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… | 2,700 | $230 | $625.2K |
| 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… | 1,220 | $270 | $329.4K |
| 43248 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum; then through the scope, he passes a guidewire over which he passes dilators through the… | 770 | $180 | $138.4K |
| 43450 | The provider passes long thin tubular devices of increasing diameter to dilate, or widen, a stricture in the patient’s esophagus to improve swallowing. | 470 | $80 | $38.2K |
| 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… | 60 | $240 | $15.3K |
| 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. | 20 | $170 | $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… | 250 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 20 | $0 | $0 |
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
9 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. | 19 | 170 | 1,300 | $230 | $441K |
| 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 | 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… | 18 | 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… | 61 | 90 | 170 | $400 | $145.8K |
| 43248 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum; then through the scope, he passes a guidewire over which he passes dilators through the… | 1 | 20 | 50 | $170 | $36.5K |
| 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. | 13 | 20 | 30 | $190 | $19.2K |
| 43450 | The provider passes long thin tubular devices of increasing diameter to dilate, or widen, a stricture in the patient’s esophagus to improve swallowing. | 2 | 10 | 50 | $40 | $7.9K |
| 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… | 11 | 20 | 260 | $1 | $1 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 10 | 10 | 180 | $1 | $1 |
Other providers in the same ZIP code as Tri-state Gastroenterology Associates, Psc, ranked by combined Medicare and Medicaid revenue.
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