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NPI 1689216152 · Lexington, KY · Ambulatory Surgical Clinic/Center
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Baptist Health Surgery Center LLC is a ambulatory surgical clinic/center provider located in Lexington, Kentucky. This profile covers 34 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 | Baptist Health Surgery Center LLC |
| Address | 3000 Baptist Health Blvd Ste 110 |
| City | Lexington |
| State | KY |
| ZIP | 40509 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | October 16, 2019 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $2.9M |
| Medicare | $1.8M |
This facility reports $1.8M in lifetime Medicare revenue and $2.9M in lifetime Medicaid revenue, indicating a Medicaid-weighted payer mix rather than a Medicare-dominant profile; both payers are active for the center, with Medicaid representing the larger share of lifetime billing. The provider is not effectively single‑payer but shows a clear tilt toward Medicaid-sourced activity.
Revenue concentration differs sharply by payer: precomputed metrics show the top 3 Medicare codes account for 38.1% of Medicare revenue, driven by 66984, C9740, and 63685. Those Medicare codes indicate a mix of ophthalmic (cataract/lens implant), urologic/transprostatic implant, and spinal neurostimulator generator procedures that together drive a large portion of the center’s Medicare receipts.
Medicaid revenue is highly concentrated: the top 3 Medicaid codes account for 94.3% of the provider’s Medicaid revenue, with 41899 alone representing $2.2M (76.0% of Medicaid revenue). This extreme concentration on 41899, together with L8699 and 43239, shows the center’s Medicaid business is dominated by unspecified dental procedures and prosthetic implants plus some endoscopy work rather than a broad mix of ambulatory surgical services.
The code mix signals the center operates as an ambulatory surgical clinic with multiple specialty lines: high-volume ophthalmic and vitreoretinal CPTs (multiple 670xx codes and 66984), upper‑GI endoscopy/biopsy (43239/43249), colorectal procedures (45385/45380), and several pain/neuromodulation codes (63650, 63685, 64561). On the Medicaid side, the dominance of 41899 and L8699 suggests a substantial dental/prosthetics service-line embedded within the ASC’s case mix or billing stream.
Competitive standing is uneven across service lines: for Medicare the center posts notably above-typical national volume on select ophthalmology and endoscopy codes (67036 ranks #49 of 832 providers nationally, 94th percentile, described as notably above typical; 43249 ranks #91 of 3500, 97th percentile, also notably above typical). By contrast, the center’s Medicare neurostimulator generator activity (63685) is a modest national presence (ranks #1135 of 1281, 0th percentile) indicating it is not a major national player in that specific device-surgery market.
Within the state Medicaid market the center shows meaningful relative positioning for dental/prosthetic activity: 41899 ranks #12 of 42 in-state (73rd percentile, typical) while L8699 ranks #2 of 8 in-state (86th percentile, typical), signaling above-average in-state concentration for prosthetic implant work. Other Medicaid procedures such as common endoscopy and colorectal codes are materially smaller contributors and generally sit at lower in‑state percentiles, underscoring the dominance of the dental/prosthetic line in Medicaid revenue.
The extreme Medicaid concentration (top 3 codes = 94.3% of Medicaid revenue) and the single-code dominance of 41899 ($2.2M, 76.0% of Medicaid revenue) constitute a revenue concentration profile that would materially affect financial sensitivity to changes in reimbursement or payer policy for those specific codes. Operational or contracting changes that impact dental/prosthetic coding or coverage would likely have outsized effects on the center’s Medicaid revenue stream.
The provider’s NPI was enumerated on 2019-10-16 (~7 years ago), indicating relatively recent enrollment compared with long-established ASCs; the rapid accumulation of large Medicaid volumes (particularly in 41899 and L8699) since enumeration suggests focused growth or specialization in dental/prosthetic services within a short operating window. This tenure detail is relevant for payers and analysts assessing credentialing history and the pace of service-line development.
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 |
|---|---|---|---|---|
| 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… | 320 | $810 | $261K |
| C9740 | Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants | 40 | $5,220 | $214.1K |
| 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… | 10 | $18,290 | $201.2K |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 50 | $3,630 | $163.5K |
| 64561 | The provider, under imaging guidance, implants electrodes around nerves in the sacral region to reduce the pain along the path of the nerve. | 30 | $3,690 | $118.1K |
| 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… | 260 | $410 | $105.1K |
| 67036 | The provider removes vitreous fluid from the eye to access the posterior segment of the eye and introduce surgical instruments through incisions in the pars plana. | 70 | $1,450 | $93.9K |
| 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… | 40 | $1,650 | $66.2K |
| 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. | 120 | $540 | $63.4K |
| 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… | 30 | $2,260 | $56.5K |
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
34 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 64561 | 4 | 10 | 40 | $3,320 | $302.3K |
| C9740 | 1 | 10 | 40 | $5,180 | $155.3K |
| 63685 | 14 | 20 | 20 | $6,870 | $116.9K |
| 63650 | 10 | 20 | 50 | $1,620 | $81K |
| 66984 | 222 | 310 | 1,560 | $40 | $67.1K |
| 66991 | 8 | 10 | 30 | $1,390 | $43K |
| 67036 | 3 | 20 | 20 | $910 | $28.1K |
| 67040 | 4 | 10 | 20 | $1,030 | $24.7K |
| 67041 | 9 | 10 | 20 | $1,020 | $24.5K |
| 64635 | 39 | 90 | 40 | $390 | $23.5K |
Showing 1–10 of 34
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 |
|---|---|---|---|---|
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 2,150 | $1,030 | $2.2M |
| L8699 | Prosthetic implant, not otherwise specified | 1,590 | $200 | $309.7K |
| 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. | 1,080 | $200 | $219.3K |
| 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… | 270 | $420 | $111.6K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 50 | $340 | $17.4K |
| 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… | 50 | $330 | $14.7K |
| 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… | 30 | $380 | $10.9K |
| 47563 | The provider removes the gallbladder through a laparoscope, a tubular instrument with a light source and camera inserted through the abdominal wall, to treat gallbladder disease. She injects dye and… | 20 | $350 | $7.1K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 30 | $190 | $4.7K |
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
9 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. | 12 | 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. | 95 | 170 | 1,300 | $230 | $441K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 46 | 60 | 160 | $780 | $292.2K |
| 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 | 70 | 210 | $310 | $290K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 61 | 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… | 107 | 120 | 300 | $320 | $215.2K |
| L8699 | Prosthetic implant, not otherwise specified | 2 | 10 | 210 | $180 | $189.3K |
| 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… | 80 | 110 | 230 | $340 | $175.7K |
| 47563 | The provider removes the gallbladder through a laparoscope, a tubular instrument with a light source and camera inserted through the abdominal wall, to treat gallbladder disease. She injects dye and… | 13 | 20 | 70 | $910 | $130.7K |
Other providers in the same ZIP code as Baptist Health Surgery Center LLC, ranked by combined Medicare and Medicaid revenue.
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