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NPI 1639158645 · Missoula, MT · Ambulatory Surgical Clinic/Center
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Big Sky Surgery Center, LLC is a ambulatory surgical clinic/center provider located in Missoula, Montana. This profile covers 25 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 | Big Sky Surgery Center, LLC |
| Address | 2833 Fort Missoula Rd |
| City | Missoula |
| State | MT |
| ZIP | 59804 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | January 10, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $954.6K |
| Medicare | $811.5K |
Payer mix and scale: BIG SKY SURGERY CENTER reports $811.5K in lifetime Medicare revenue and $954.6K in lifetime Medicaid revenue, indicating Medicaid is the slightly larger single-payer revenue source for this entity. Both payers contribute meaningfully to the center’s overall volume, so changes in either Medicare or Medicaid reimbursement or referral flows could materially affect total revenue.
Medicaid revenue concentration and service-line focus: Medicaid billing is highly concentrated — the precomputed top 3 Medicaid codes account for 96.2% of Medicaid revenue — and is dominated by pediatric ENT procedures, led by 42820 (tonsil/adenoid removal) which alone represents $749.8K and 78.5% of the provider’s Medicaid revenue. The second-largest Medicaid code, 69436 (tympanostomy), contributes $144.8K (15.2%), reinforcing that the center’s Medicaid business is effectively centered on high-volume pediatric ENT services.
Medicare revenue concentration and a dominant Medicare procedure: Medicare revenue shows a moderate concentration with the top 3 codes accounting for 41.7% of Medicare revenue. The single largest Medicare driver is 29827 (arthroscopic rotator cuff repair) at $183K and 22.6% of Medicare revenue; this code’s national rank (#28 of 3445, 99th percentile) is labeled an "extreme outlier," signaling an unusually high national volume for that specific procedure at this facility.
Multispecialty ambulatory surgical mix: The Medicare CPT list contains substantial volumes across orthopedics (29827, 27447, 23430), ENT/rhinology (31276, 31267, 31257, 30140), urology (52332, 52356, 52601) and pain injections (64483, 62323). This pattern—combined with the facility’s taxonomy as an Ambulatory Surgical Clinic/Center—indicates the center operates as a multispecialty ASC handling both elective orthopedic and ENT procedures plus urologic and pain-management services.
Competitive standing by payer and code: For Medicare, the provider is a national outlier on 29827 (rank #28/3445, 99th percentile, "extreme outlier") and shows notably above-typical volume on 52332 (rank #209/3938, 95th percentile), suggesting pockets of national-scale specialization within an otherwise typical procedural mix. For Medicaid, the provider ranks #3 of 16 in-state for 42820 (87th percentile) and #5 of 18 for 69436 (76th percentile), positioning it as one of the higher-volume pediatric ENT facilities in Montana.
Revenue concentration risk and operational implications: The extreme concentration of Medicaid revenue in a small number of pediatric ENT codes (96.2% top-3 share) creates exposure to any policy, coverage, or demand changes affecting those procedures; conversely, Medicare revenue is less concentrated but still materially influenced by a single high-volume orthopedic code (29827 at 22.6% of Medicare revenue). Payer-specific reliance like this suggests strategic sensitivity to state Medicaid program changes and to referral patterns for shoulder surgery in the Medicare population.
Tenure and likely referral network effects: The provider’s NPI was enumerated on 2006-01-10 (~20 years ago), indicating a long-established ambulatory surgical center. That tenure, combined with concentrated high-volume procedures (notably 29827 and 42820), is consistent with developed referral relationships in both orthopedic and pediatric ENT care pathways.
Statistical outlier characterization across payers: The dataset contains both extreme outlier behavior (29827 labeled "extreme outlier") and many codes at "typical, unremarkable" volumes; this mixture implies the center is a focused high-volume provider for a few procedures while functioning as a conventional ASC for a broad set of other surgeries and interventions.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
25 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 100 | $1,830 | $183K |
| 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… | 10 | $7,020 | $84.2K |
| 23430 | In this procedure, the provider surgically cleans the long tendon of the biceps from its damaged fragment and fixes the tendon to the upper end of the humerus to improve the stability of the joint.… | 20 | $3,090 | $71.2K |
| 29828 | The provider examines the tissue inside the shoulder joint with an arthroscope. She inserts additional instruments to repair an unstable biceps tendon, the fibrous band that connects the biceps… | 20 | $2,360 | $56.7K |
| 52332 | The provider performs cystourethroscopy, the inspection of the interior of the bladder, the urethra, prostatic urethra, and ureteric openings using a cystoscope passed through the urethra and into… | 50 | $890 | $44.3K |
| 31276 | In this procedure, the provider inserts an endoscope into the frontal sinus to explore it for abnormalities. The provider may also remove bone, scar tissue, polyps, or other tissue from the frontal… | 30 | $1,280 | $38.3K |
| 64721 | Neuroplasty or transposition of the median nerve at the carpal tunnel is done to treat a condition called carpal tunnel syndrome (CTS). The carpal tunnel is a narrow tunnel in the wrist through which… | 70 | $560 | $37.5K |
| 52601 | During transurethral resection of the prostate (TURP), the surgeon inserts a resectoscope via the urethra and removes a portion of the prostate. This procedure includes several other urological… | 20 | $1,670 | $31.7K |
| 52356 | The provider performs a cystourethroscopy, the inspection of the interior of the bladder, the urethra, prostatic urethra, and ureteric openings using a cystoscope passed through the urethra and into… | 20 | $1,580 | $31.7K |
| 30140 | This CPT code is for a submucous resection of the inferior turbinate (partial or complete by any method). | 70 | $450 | $29.8K |
Showing 1–10 of 25
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 25 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
25 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 27447 | 73 | 80 | 40 | $1,080 | $60.6K |
| 31267 | 1 | 10 | 30 | $1,080 | $27K |
| 29827 | 1 | 30 | 20 | $860 | $26.7K |
| 31276 | 1 | 10 | 30 | $880 | $23K |
| 64721 | 6 | 20 | 60 | $400 | $20.5K |
| 23430 | 3 | 20 | 10 | $1,230 | $18.5K |
| 29828 | 4 | 10 | 20 | $770 | $18.4K |
| C9290 | 5 | 10 | 13,300 | $1 | $16.4K |
| 52234 | 1 | 10 | 20 | $1,090 | $16.3K |
| 64483 | 20 | 40 | 40 | $170 | $14.2K |
Showing 1–10 of 25
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 |
|---|---|---|---|---|
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 330 | $2,290 | $749.8K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 190 | $760 | $144.8K |
| 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). | 90 | $270 | $24K |
| 30140 | This CPT code is for a submucous resection of the inferior turbinate (partial or complete by any method). | 20 | $1,120 | $18K |
| 30520 | Septoplasty is most often performed for a deviated septum which can be either C–shaped, S–shaped, or a cartilaginous deviation. | 10 | $690 | $8.3K |
| 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)… | 30 | $220 | $5.6K |
| G0260 | Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography | 20 | $190 | $4.2K |
| 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… | 100 | $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 Montana providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Montana median
9 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. | 3 | 20 | 40 | $1,180 | $169.3K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 5 | 20 | 30 | $400 | $56.1K |
| 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). | 5 | 20 | 30 | $180 | $28.5K |
| 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 | 10 | 90 | $60 | $18.9K |
| 30140 | This CPT code is for a submucous resection of the inferior turbinate (partial or complete by any method). | 2 | 10 | 40 | $360 | $13.6K |
| 30520 | Septoplasty is most often performed for a deviated septum which can be either C–shaped, S–shaped, or a cartilaginous deviation. | 2 | 10 | 10 | $490 | $6.3K |
| G0260 | Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography | 2 | 10 | 20 | $20 | $1.4K |
| 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… | 6 | 10 | 140 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 5 | 10 | 40 | $0 | $0 |
Other providers in the same ZIP code as Big Sky Surgery Center, LLC, ranked by combined Medicare and Medicaid revenue.
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