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NPI 1629045133 · Charlottesville, VA · Ambulatory Surgical Clinic/Center
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Monticello Community Surgery Center, LLC is a ambulatory surgical clinic/center provider located in Charlottesville, Virginia. This profile covers 31 Medicare and 5 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 | Monticello Community Surgery Center, LLC |
| Address | 2331 Seminole Lane |
| City | Charlottesville |
| State | VA |
| ZIP | 22901 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | March 2, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.8M |
| Medicaid | $328.5K |
MONTICELLO COMMUNITY SURGERY CENTER, LLC is registered as an Ambulatory Surgical Clinic/Center and has an established NPI (enumerated 2006-03-02, ~20 years ago), consistent with a long-standing outpatient surgery operation. The overall billing footprint is heavily weighted toward Medicare ($2.8M total Medicare revenue) with a smaller Medicaid presence ($328.5K total Medicaid revenue), indicating Medicare is the dominant payer by scale for this ASC.
Revenue concentration on Medicare is extreme: the precomputed top-three Medicare codes account for 79.0% of the provider’s Medicare revenue, driven primarily by 66984 (69.4% of Medicare revenue), with 65820 (5.4%) and 0449T (4.1%) rounding out the top three. This mix identifies cataract extraction with intraocular lens insertion and glaucoma-related procedures as the core service lines generating the majority of Medicare receipts.
Medicaid billing is effectively single-code concentrated: 66984 alone accounts for 100.0% of the provider’s Medicaid revenue, with that code showing 1K claims and $328.4K revenue at $321 avg paid/claim. Several other Medicaid-listed codes (for example G8918 and V2632) appear on the file with claims but $0 reported paid amounts, which suggests administrative lines or non‑paid service indicators on the Medicaid feed rather than meaningful paid Medicaid diversification.
On competitive standing, the practice is a high-volume national outlier for key ophthalmic services: Medicare 66984 ranks #708 of 15965 providers (96th percentile) and is described as notably above typical national volume, 65820 ranks #47 of 1249 (96th percentile) also notably above typical national volume, and 0449T ranks #6 of 95 providers (94th percentile) indicating top-tier national activity for this specialized glaucoma device insertion. These ranks support characterization of the ASC as a major regional/national participant specifically for cataract and certain glaucoma interventions.
Although ophthalmology dominates, the claim mix shows a modest breadth of ambulatory procedures beyond cataract and glaucoma: Medicare-level billing includes corneal transplant codes (65756, V2785), intraocular lens and implant-related codes (66982, 66991), as well as non-ophthalmic procedures such as spinal injections (64493, 62323, 64483) and minor hand/foot operations (64721, 28285). These ancillary lines each represent much smaller shares of revenue (individual codes generally under ~2–3% of Medicare revenue) but indicate the ASC either hosts multiple specialty sessions or contracts with visiting specialists to expand service offerings.
The provider’s per-claim payments further underscore payer differences: Medicare 66984 shows 2.4K claims at $798 avg paid/claim and Medicaid 66984 shows 1K claims at $321 avg paid/claim, reflecting materially lower Medicaid unit payments for the same dominant procedure. This pattern—high Medicare volume and higher Medicare reimbursement per claim—helps explain why Medicare ($2.8M) so substantially outpaces Medicaid ($328.5K) in total revenue for this entity.
Not all billed lines are specialty outliers; several codes are labeled and rank as typical or lower-volume relative to peers (for example C9740 is characterized as typical/unremarkable volume at the 11th percentile, V2785 at the 21st percentile, and multiple injection/diagnostic codes fall in mid-range percentiles). The mix of high-percentile ophthalmic codes alongside many typical‑volume ancillary codes suggests the ASC’s competitive advantage is concentrated in a small set of high-volume eye procedures while other service lines are routine and modest.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
31 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 2,440 | $800 | $1.9M |
| 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. | 110 | $1,420 | $151.9K |
| 0449T | The provider inserts the first aqueous drainage device into the interior of the eye with its end in the subconjunctival space; the device does not include a reservoir to hold the fluid. The device… | 50 | $2,240 | $116.2K |
| 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… | 110 | $790 | $86.5K |
| C9740 | Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants | 10 | $5,410 | $70.4K |
| 65756 | During this procedure, the provider performs a complete corneal transplant to replace a damaged corneal endothelium. | 50 | $1,470 | $66.3K |
| V2785 | Processing, preserving and transporting corneal tissue | 20 | $3,530 | $59.9K |
| 66991 | The provider inserts an intraocular lens prosthesis during the same session as extracapsular cataract extraction. The provider also inserts one or more anterior segment aqueous drainage devices in… | 20 | $2,450 | $51.5K |
| 64493 | The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance… | 120 | $270 | $33.1K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 50 | $590 | $31.8K |
Showing 1–10 of 31
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 31 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
31 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J1096 | 10 | 10 | 1,630 | $100 | $256.8K |
| J1097 | 13 | 10 | 1,400 | $80 | $248K |
| C9740 | 5 | 10 | 30 | $5,580 | $189.6K |
| V2785 | 5 | 10 | 40 | $3,750 | $146.1K |
| 66984 | 55 | 380 | 250 | $130 | $139K |
| 65820 | 6 | 40 | 30 | $1,110 | $63.1K |
| 66991 | 23 | 30 | 30 | $1,460 | $61.3K |
| 0449T | 1 | 10 | 30 | $1,540 | $41.6K |
| 15823 | 24 | 30 | 50 | $530 | $34.5K |
| 67904 | 16 | 20 | 50 | $580 | $32.8K |
Showing 1–10 of 31
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.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 1,020 | $320 | $328.4K |
| 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… | 130 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 80 | $0 | $0 |
| J0665 | Injection, bupivicaine, not otherwise specified, 0.5 mg | 20 | $0 | $0 |
| V2632 | Posterior chamber intraocular lens | 480 | $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
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 13 | 50 | 200 | $350 | $282.9K |
| V2632 | Posterior chamber intraocular lens | 6 | 20 | 110 | $1 | $170 |
| J0665 | Injection, bupivicaine, not otherwise specified, 0.5 mg | 47 | 50 | 250 | $1 | $90 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 8 | 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… | 16 | 30 | 150 | $1 | $10 |
Other providers in the same ZIP code as Monticello Community Surgery Center, LLC, ranked by combined Medicare and Medicaid revenue.
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