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NPI 1598797714 · Lynchburg, VA · Ambulatory Surgical Clinic/Center
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Surgery Center Of Lynchburg LLC is a ambulatory surgical clinic/center provider located in Lynchburg, Virginia. This profile covers 40 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 | Surgery Center Of Lynchburg LLC |
| Address | 2401 Atherholt Rd |
| City | Lynchburg |
| State | VA |
| ZIP | 24501 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | July 7, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $4M |
| Medicaid | $799.8K |
The provider’s Medicare billing mix is heavily weighted toward major orthopedic and ophthalmologic procedures, with 27447 (knee replacement) generating $1.3M in Medicare revenue at $6577 avg paid/claim, 66984 (routine cataract extraction with IOL) producing $942.7K at $783 avg paid/claim, and 27130 (hip replacement) contributing $492.5K at $6746 avg paid/claim. This pattern is consistent with an ambulatory surgical center focused on same-day or short-stay joint arthroplasty and high-volume ophthalmology cases rather than primarily primary care or chronic-disease services.
Medicare revenue is concentrated: the precomputed top-3 Medicare codes account for 72.8% of the provider’s total Medicare revenue, driven by 27447 (34.7%), 66984 (25.0%), and 27130 (13.1%). This concentration indicates that a small set of high-revenue procedures underpins most Medicare receipts and that changes in demand, reimbursement, or referral patterns for these procedures would materially affect the facility’s Medicare topline.
On the Medicaid side, revenue is even more concentrated with the precomputed top-3 Medicaid codes accounting for 88.8% of total Medicaid revenue. The Medicaid mix is dominated by pediatric ENT and related procedures: 69436 (tympanostomy with tube) accounts for $374.1K (46.8%) and 42820 (tonsil/adenoid removal in <12) accounts for $261.7K (32.7%), while 64483 (transforaminal epidural injection) contributes $74.2K (9.3%).
The provider’s payer mix is Medicare-dominant in scale: reported lifetime Medicare revenue is $4M versus $799.8K from Medicaid. Medicare therefore represents the clear majority of billed revenue on file, making the practice more sensitive to Medicare policy and referral patterns while Medicaid is a secondary but highly procedure-concentrated payer.
National and procedure-level competitive standing is mixed: for Medicare the provider is an extreme outlier on 27447 (rank #94 of 12089, 99th percentile) and also an extreme outlier on 52000 (rank #64 of 8548, 99th percentile), indicating unusually high national volume for knee replacements and cystoscopy relative to peers. Other high-revenue Medicare codes like 66984 and 27130 sit in typical-to-high percentiles (89th and 92nd), signaling that the facility is a major regional player for several high-value surgical services but not uniformly dominant across all its codes.
In-state competitive positioning for Medicaid shows strong pediatric surgical volume: 69436 ranks #8 of 46 in-state (84th percentile) and 42820 ranks #7 of 31 in-state (80th percentile), which supports the conclusion that the center is a leading regional site for tympanostomy and tonsil/adenoid procedures for Medicaid patients. By contrast, some interventional pain and spine injections have mixed state rankings (for example, 62321 ranks #2 of 13 in-state, 92nd percentile, while 64635 ranks #12 of 14, 8th percentile), indicating pockets of strength and weakness across subspecialty services.
The provider has an established operating history: NPI was enumerated on 2006-07-07 (~20 years ago), which suggests long-tenure local presence and likely established referral relationships with surgeons and ophthalmologists in the Lynchburg market. That tenure, combined with concentrated high-revenue procedures, implies the facility has invested in the clinical capability and scheduling infrastructure needed to support repeated high-volume surgical workflows.
Several individual CPTs are flagged as statistical outliers or notably above typical volumes, which has operational implications: 27447 and 52000 are labeled "extreme outlier" nationally, while 29848 and 62321 are described as "notably above typical" in their national/state comparisons. These outlier designations suggest the center has specialized capacity and referral pipelines for specific procedures rather than a broadly distributed case mix, a factor payers should consider when evaluating network adequacy and capacity for particular surgical services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
40 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 27447 | In this procedure, the provider replaces the damaged weight bearing surfaces of both the medial and lateral compartments in the knee joint using implants of metal or other strong materials. The… | 200 | $6,580 | $1.3M |
| 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… | 1,200 | $780 | $942.7K |
| 27130 | In this procedure, the provider surgically replaces the hip joint by prosthesis, or artificial hip joint. He replaces both the femoral and acetabular components with or without using an autograft or… | 70 | $6,750 | $492.5K |
| 52000 | In this procedure, the provider performs an examination of the interior of the bladder, the urethra, and the ureteric openings by means of a cystourethroscope, a thin flexible or rigid tube with a… | 550 | $190 | $105.6K |
| 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… | 130 | $790 | $98.6K |
| 0275T | N/A | 20 | $3,450 | $72.5K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 120 | $600 | $71.6K |
| 29827 | The provider examines the tissue inside the shoulder joint with an arthroscope. She inserts additional instruments to repair a torn rotator cuff, the grouping of muscles and tendons that surround and… | 40 | $1,460 | $62.6K |
| 29848 | The provider inserts an endoscope into the wrist joint to divide the transverse carpal ligament and reduce compression on the median nerve in the carpal tunnel that results in pain and numbness. | 120 | $490 | $56.4K |
| 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). | 180 | $290 | $51.5K |
Showing 1–10 of 40
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 40 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
40 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J1096 | 8 | 10 | 1,630 | $100 | $256.8K |
| 66984 | 108 | 380 | 250 | $130 | $139K |
| 27447 | 4 | 310 | 40 | $1,150 | $64.4K |
| 66991 | 27 | 30 | 30 | $1,460 | $61.3K |
| J0585 | 46 | 60 | 6,400 | $1 | $51.9K |
| 22514 | 20 | 20 | 20 | $2,360 | $47.3K |
| 27130 | 31 | 210 | 40 | $1,040 | $45.9K |
| 25609 | 7 | 10 | 20 | $1,780 | $32K |
| 64483 | 46 | 170 | 80 | $210 | $31.4K |
| 0275T | 3 | 10 | 20 | $1,570 | $29.8K |
Showing 1–10 of 40
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 |
|---|---|---|---|---|
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 800 | $470 | $374.1K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 330 | $800 | $261.7K |
| 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). | 460 | $160 | $74.2K |
| 52000 | In this procedure, the provider performs an examination of the interior of the bladder, the urethra, and the ureteric openings by means of a cystourethroscope, a thin flexible or rigid tube with a… | 210 | $180 | $37K |
| 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… | 130 | $210 | $27.1K |
| 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)… | 70 | $260 | $17.7K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 20 | $430 | $6.9K |
| 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)… | 10 | $90 | $1.1K |
| 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… | 760 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 60 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Virginia median
10 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 7 | 30 | 50 | $1,670 | $401.7K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 8 | 50 | 110 | $840 | $309.8K |
| 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… | 30 | 50 | 200 | $350 | $282.9K |
| 52000 | In this procedure, the provider performs an examination of the interior of the bladder, the urethra, and the ureteric openings by means of a cystourethroscope, a thin flexible or rigid tube with a… | 4 | 10 | 60 | $910 | $262.5K |
| 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). | 10 | 30 | 180 | $320 | $121.7K |
| 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)… | 36 | 40 | 70 | $350 | $96.4K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 12 | 10 | 70 | $570 | $88.5K |
| 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)… | 2 | 10 | 30 | $480 | $55.9K |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 11 | 20 | 70 | $1 | $20 |
| 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 | 30 | 150 | $1 | $10 |
Other providers in the same ZIP code as Surgery Center Of Lynchburg LLC, ranked by combined Medicare and Medicaid revenue.
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