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NPI 1558390781 · Lexington, KY · Ambulatory Surgical Clinic/Center
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Baptist-physicians Surgery Center is a ambulatory surgical clinic/center provider located in Lexington, Kentucky. This profile covers 34 Medicare and 12 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 | Baptist-physicians Surgery Center |
| Address | 1720 Nicholasville Rd |
| City | Lexington |
| State | KY |
| ZIP | 40503 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | July 1, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $5.8M |
| Medicare | $1.3M |
Scale and payer mix: BAPTIST-PHYSICIANS SURGERY CENTER reports $1.3M in lifetime Medicare revenue and $5.8M in lifetime Medicaid revenue, indicating Medicaid is the dominant payer by scale for this center. The disparity suggests the facility’s case-mix and commercial contracts are more heavily aligned with Medicaid populations or payer sources that feed Medicaid volume.
Revenue concentration across payers: the provider’s Medicare revenue is materially concentrated, with the top 3 Medicare codes accounting for 42.4% of Medicare revenue, while the top 3 Medicaid codes account for 78.4% of Medicaid revenue. This asymmetric concentration on a very small set of codes—especially on the Medicaid side—means revenue is sensitive to utilization or reimbursement shifts affecting those specific services.
Service-line posture: the documented CPT mix aligns with a high-volume ambulatory surgical center focused on gastrointestinal endoscopy and interventional procedures. On Medicare, leading codes include 45385 (therapeutic colonoscopy), 63650 (epidural electrode placement for pain), and 43239 (upper endoscopy with biopsy); on Medicaid the largest contributors are 41899 (dental-related procedures), 43239, and 45385, indicating the center performs both GI endoscopy suites and a sizable volume of dental/ORA-coded procedures under Medicaid.
Medicare competitive standing: the provider is a national outlier for colonoscopic snare polypectomy (45385), which is labeled an "extreme outlier" and ranks #222 of 16310 providers nationally (99th percentile), and it has notably above-typical national volume for 43239 (97th percentile). By contrast, 63650 (epidural electrode placement) sits at a more typical national position (67th percentile). Overall, the facility punches above its peer group on select endoscopy codes at a national level while remaining more typical on several interventional pain services.
Medicaid competitive standing: the center is a dominant in-state performer for colonoscopic procedures—45385 is ranked #1 of 105 providers in-state (100th percentile; extreme outlier) and 43239 ranks in-state at the 91st percentile (notably above typical). The Medicaid code 41899 produces $2.4M (41.1% of Medicaid revenue) and ranks #6 of 42 in-state (88th percentile), so the provider is also a top regional performer for that uncoded dental procedure category. These positions identify the center as a major state-level provider for both colonoscopy and certain dental/upper-GI services under Medicaid.
Top-code Medicaid dependence: 41899 ($2.4M, 41.1% of Medicaid revenue), 43239 ($1.3M, 21.5% of Medicaid revenue), and 45385 ($924.7K, 15.8% of Medicaid revenue) are the three Medicaid revenue drivers cited in the data and together constitute the precomputed 78.4% share of Medicaid revenue. That concentration—centered on one uncoded dental category plus two endoscopy codes—creates operational dependence on those service lines for Medicaid revenue.
Operational implications and clinical breadth: the code mix combines high-volume gastrointestinal endoscopy (multiple colonoscopy and EGD codes), interventional pain/neurostimulation procedures (63650, 64483, 64635 range), and gynecologic laparoscopy (58661 appears meaningfully in Medicaid volume), indicating the ASC supports multi-specialty procedural workflows rather than a single narrow specialty. Contracting, scheduling and staffing decisions should reflect this blend of GI, pain management, and procedural gynecology/dental activity, given how heavily these services drive revenue.
Tenure and market presence: the NPI was enumerated 2006-07-01 (~20 years ago), so the center has an established enrollment history that could support the accumulation of the high, concentrated volumes observed, especially for colonoscopy and Medicaid dental-related services. The combination of long tenure and concentrated high-volume codes suggests these are sustained service lines rather than transient spikes.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
34 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… | 610 | $410 | $251.9K |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 60 | $3,620 | $217K |
| 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. | 360 | $210 | $76.3K |
| 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. | 140 | $540 | $74K |
| 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). | 250 | $270 | $67.1K |
| 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… | 240 | $260 | $63.2K |
| 49505 | The provider repairs an initial inguinal hernia on a child, five years of age or older. She pushes the hernia back to reduce it. | 40 | $1,240 | $52K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 120 | $390 | $48.9K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 90 | $470 | $40.2K |
| 58558 | The provider either biopsies the lining of the uterus (endometrium) or removes polyps, or both, through a hysteroscope ; he may or may not perform a dilation and curettage (D&C). He sends all samples… | 40 | $1,060 | $39.3K |
Showing 1–10 of 34
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 34 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.
12 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 2,590 | $930 | $2.4M |
| 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. | 5,070 | $250 | $1.3M |
| 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… | 2,690 | $340 | $924.7K |
| 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… | 2,040 | $220 | $437.5K |
| 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… | 1,010 | $330 | $337.7K |
| 58661 | The provider removes one or both ovaries and one or both fallopian tubes or a combination of both using a laparoscope. | 190 | $1,430 | $264.7K |
| 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. | 470 | $330 | $154.3K |
| 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). | 150 | $250 | $36.1K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 40 | $620 | $24.3K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 20 | $320 | $4.8K |
Showing 1–10 of 12
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
12 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. | 6 | 40 | 740 | $1,170 | $1.7M |
| 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. | 17 | 170 | 1,300 | $230 | $441K |
| 58661 | The provider removes one or both ovaries and one or both fallopian tubes or a combination of both using a laparoscope. | 5 | 20 | 110 | $1,650 | $377.6K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 65 | 80 | 260 | $430 | $263.3K |
| 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… | 14 | 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… | 1 | 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… | 11 | 90 | 170 | $400 | $145.8K |
| 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). | 9 | 20 | 120 | $120 | $136.4K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 6 | 10 | 30 | $460 | $48.2K |
| 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. | 1 | 20 | 30 | $190 | $19.2K |
Showing 1–10 of 12
Other providers in the same ZIP code as Baptist-physicians Surgery Center, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Baptist Healthcare System, Inc | KY | General Acute Care Hospital | $0 | $98.1M |
| Encore Adhc, LLC | KY | Adult Day Care Clinic/Center | $0 | $51.9M |
| Center For Comprehensive Services, Inc | KY | Rehabilitation Hospital | $0 | $28.7M |
| Lhcg Lxx, LLC | KY | Home Health Agency | $0 | $27.1M |
| P & C Labs, LLC | KY | Clinical Medical Laboratory | $427.3K | $18M |
| Healthfirst Bluegrass Inc | KY | Federally Qualified Health Center (FQHC) | $0 | $18.1M |
| Ndt Care Services, LLC | KY | Community/Behavioral Health Agency | $0 | $17.5M |
| Lexington Urgent Care PLLC | KY | Urgent Care Clinic/Center | $0 | $16.7M |
| Ballard Wright, Md, Psc | KY | Interventional Pain Medicine Physician | $0 | $12.4M |
| Big Smiles Kentucky Psc | KY | Dentist | $0 | $12.3M |
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