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NPI 1487857322 · Langhorne, PA · Pain Clinic/Center
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Pain Management Centers Of America, LLC is a pain clinic/center provider located in Langhorne, Pennsylvania. This profile covers 17 Medicare and 4 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 | Pain Management Centers Of America, LLC |
| Address | 820 Town Center Dr |
| City | Langhorne |
| State | PA |
| ZIP | 19047 |
| Taxonomy | Pain Clinic/Center |
| NPI Enumerated | June 7, 2007 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4.6M |
| Medicaid | $74.2K |
This provider’s billing is overwhelmingly Medicare-driven: lifetime Medicare revenue is $4.6M versus $74.2K in Medicaid, so Medicare is the dominant payer by scale while Medicaid represents a very small share of total reported revenue. The provider should be treated operationally as a Medicare-focused interventional practice rather than a Medicaid-centered clinic.
Medicare revenue is highly concentrated in a small set of device- and procedure-based codes: the precomputed top 3 Medicare codes by revenue account for 73.4% of the provider’s Medicare revenue, led by 0275T ($1.6M, 33.6%), 63685 ($1.1M, 23.4%), and 63650 ($762.7K, 16.4%). These three codes dominate the Medicare book-of-business and are the primary levers of revenue risk and utilization for payers analyzing this entity.
The procedure mix indicates a specialized interventional pain and device implant operation: 63685 (spinal neurostimulator pulse generator implantation), 63650 (epidural electrode placement), and a range of image-guided spinal injections (e.g., 62323, 62321) point to a practice focused on neurostimulation and interventional spine therapies rather than only conservative pain management. The presence of device implantation and stabilization codes (for example 22869) further supports a device-heavy, procedure-centric service line.
Statistically, the provider is an outlier on at least one Medicare code and elevated on other device codes: 0275T ranks #1 of 597 nationally and is labeled an "extreme outlier, far above typical national volume for this code," while 63685 (rank #43 of 1281, 96th percentile) and 63650 (rank #26 of 1371, 98th percentile) are both described as "notably above typical national volume for this code." This combination suggests a rare specialization or unusually high national market share for those neurostimulation services.
Although Medicare shows concentrated, high-value device activity, the Medicaid footprint is modest and concentrated: the top Medicaid codes by revenue account for 100.0% of Medicaid revenue, with 62323 representing $65.7K (88.5%) and 62321 $8.5K (11.5%). In-state ranking for those Medicaid services is unremarkable to modest (62323 is #42 of 74, 44th percentile; 62321 is #14 of 17, 0th percentile), indicating the provider is not a dominant Medicaid player regionally.
Payer-level unit economics reinforce a device/procedure focus: high average paid-per-claim values such as $19,393 for 63685, $3,852 for 63650, and $3,771 for 0275T show revenue is driven by higher-priced implant and procedural services rather than high-volume low-dollar injections alone. Payers reviewing utilization and prior authorization policies should be aware that single events can represent substantial dollar exposure.
The provider’s Medicare portfolio also includes a non-negligible volume of ophthalmologic procedure billing (66984 shows $648.4K, 14.0% of Medicare revenue), which is atypical for a Pain Clinic/Center taxonomy. This mixed billing pattern could reflect facility-level billing, multi-specialty affiliation, or contracted surgical services and warrants follow-up to clarify the clinical model and billing arrangements when assessing network inclusion or payment policy.
The NPI tenure is long-standing (NPI enumerated 2007-06-07 (~19 years ago)), so this is an established operation; combined with the national outlier status on 0275T and elevated ranks on other neurostimulation codes, the data point to a mature, niche capability in device-based pain interventions that payers should treat as a targeted specialty line for utilization management and contracting considerations.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
17 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 0275T | N/A | 410 | $3,770 | $1.6M |
| 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… | 60 | $19,390 | $1.1M |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 200 | $3,850 | $762.7K |
| 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… | 770 | $840 | $648.4K |
| 0627T | The provider injects a cellular or tissue–based product under fluoroscopic guidance to treat a lumbar intervertebral disc. This code applies to the first level injected. The injection may occur on… | 30 | $7,300 | $182.5K |
| 22869 | Through a minimally invasive approach, the provider inserts an interlaminar stabilization or interspinous distraction, or decompression, device (IPD) and attaches it to the bony projections (spinous… | 10 | $8,550 | $94K |
| 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)… | 210 | $250 | $53.2K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 80 | $650 | $50K |
| 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. | 30 | $1,290 | $37.3K |
| 66180 | The provider implants a shunt in the anterior chamber of the eye to facilitate drainage of aqueous humor, or fluid, in order to reduce intraocular pressure. He uses a graft to reinforce the tissue… | 20 | $2,050 | $34.8K |
Showing 1–10 of 17
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 17 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
17 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 0627T | 1 | 10 | 30 | $7,300 | $182.6K |
| 63685 | 3 | 40 | 20 | $6,350 | $139.6K |
| 0275T | 1 | 50 | 30 | $2,160 | $112.6K |
| 63650 | 1 | 40 | 40 | $1,960 | $107.6K |
| 66984 | 24 | 670 | 80 | $530 | $97.8K |
| 22869 | 2 | 10 | 10 | $3,560 | $49.9K |
| 65820 | 24 | 50 | 30 | $950 | $36.2K |
| 66180 | 10 | 20 | 20 | $1,160 | $25.5K |
| 66170 | 7 | 10 | 20 | $790 | $21.3K |
| 64483 | 114 | 340 | 60 | $190 | $18.6K |
Showing 1–10 of 17
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.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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 | $670 | $65.7K |
| 62321 | 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 cervical (neck) or thoracic (upper and middle back)… | 10 | $710 | $8.5K |
| 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… | 270 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 180 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Pennsylvania providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Pennsylvania median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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)… | 42 | 70 | 120 | $240 | $61.7K |
| 62321 | 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 cervical (neck) or thoracic (upper and middle back)… | 14 | 20 | 30 | $190 | $7.3K |
| 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… | 9 | 40 | 100 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 11 | 30 | 100 | $0 | $0 |
Other providers in the same ZIP code as Pain Management Centers Of America, LLC, ranked by combined Medicare and Medicaid revenue.
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