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NPI 1720024284 · Johnson City, TN · Ambulatory Surgical Clinic/Center
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Pma Surgery Center, LLC is a ambulatory surgical clinic/center provider located in Johnson City, Tennessee. This profile covers 10 Medicare and 4 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 | Pma Surgery Center, LLC |
| Address | 101 Med Tech Pkwy |
| City | Johnson City |
| State | TN |
| ZIP | 37604 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | June 22, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.6M |
| Medicaid | $23.6K |
PMA SURGERY CENTER, LLC’s billing mix is concentrated in spine and interventional pain procedures, consistent with its taxonomy as an Ambulatory Surgical Clinic/Center. The presence of high-revenue implant codes such as 63685 (spinal neurostimulator pulse generator insertion/replacement) and 63650 (epidural electrode placement), together with multiple facet and epidural injection codes, indicates a clinical focus on neurostimulation and image-guided spinal pain management.
Medicare revenue is highly concentrated: the provider’s top 3 Medicare codes account for 80.6% of its total Medicare revenue, driven by 63685 (42.1% of Medicare revenue), 63650 (31.7%), and 64635 (6.7%). This concentration signals that a small set of high-cost spine/pain services produce the majority of Medicare income.
On Medicare measures of national volume and standing, PMA SURGERY CENTER ranks substantially above peers for several spine codes: 63650 ranks #13 of 1371 providers nationally (99th percentile; labeled an "extreme outlier"), 63685 ranks #28 of 1281 (98th percentile; "notably above typical" national volume), and 64635 ranks #30 of 5957 (100th percentile; "extreme outlier"). These ranks characterize the center as a high-volume national outlier for selected neurostimulation and spine-intervention services rather than a modest local operator for those codes.
Medicaid billing is very small in scale relative to Medicare but concentrated: total Medicaid revenue is $23.6K and the top 3 Medicaid codes account for 100.0% of that revenue, led by 64483 (79.0%) and 64493 (21.0%). In-state rank percentiles for those Medicaid codes are modest—64483 ranks #26 of 39 in-state (34th percentile) and 64493 ranks #40 of 62 (36th percentile)—indicating the provider is a typical, non-dominant participant in Tennessee Medicaid for those injections.
Payer mix is effectively Medicare-dominant: reported Medicare revenue of $2.6M far exceeds Medicaid revenue of $23.6K, so operational and reimbursement exposure is overwhelmingly tied to Medicare payment policies and utilization patterns. Analysts should treat the entity as effectively single-payer in scale when evaluating revenue risk and contract leverage.
Procedure volumes in the file show both implant-focused and high-throughput injection work: Medicare claim counts include 252 claims for 63650 and 65 claims for 63685, alongside large counts for image-guided injection codes such as 64493 (666 claims) and 64483 (652 claims). This combination implies the ASC supports surgical device implantation workflows as well as high-volume outpatient injection suites with imaging support and staffing to manage many short procedures.
The provider has an established operational tenure—NPI enumerated 2006-06-22 (~20 years ago)—which, combined with sustained high national ranks on key spine codes, suggests a long-standing regional or specialty niche rather than a new entrant. This longevity may correlate with developed referral relationships and invested capital in device implantation and imaging capabilities.
Multiple Medicare codes carry explicit outlier labels that should draw payer attention: 63650 and 64635 are described as "extreme outlier" and 64493 and 64483 are labeled at the 100th/99th percentiles or "extreme outlier" for national volume. While not an implication of wrongdoing, these statistical outlier flags are material for utilization review, contract negotiation, and competitive benchmarking given their concentration of Medicare revenue.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 70 | $16,580 | $1.1M |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 250 | $3,220 | $810.9K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 410 | $420 | $171.4K |
| 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). | 650 | $250 | $161K |
| 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… | 670 | $220 | $145.9K |
| 64490 | The provider injects a diagnostic or therapeutic substance into a single cervical or thoracic paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging… | 250 | $230 | $56.3K |
| 64633 | In this procedure, the provider destroys the facet joint nerve of a cervical or thoracic spinal segment using neurolytic agents like heat, electric current, or a chemical compound. He makes use of… | 110 | $440 | $47.6K |
| 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)… | 160 | $210 | $33.9K |
| 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)… | 150 | $210 | $32K |
| G0260 | Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography | 120 | $170 | $20.6K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 10 CPT/HCPCS codes.
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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.
4 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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 | $130 | $18.7K |
| 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… | 60 | $90 | $5K |
| 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… | 70 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 70 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Tennessee providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Tennessee median
4 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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… | 40 | 60 | 150 | $80 | $57.9K |
| 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). | 26 | 40 | 210 | $90 | $49.7K |
| 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… | 45 | 70 | 160 | $1 | $10 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 29 | 50 | 100 | $0 | $0 |
Other providers in the same ZIP code as Pma Surgery Center, LLC, ranked by combined Medicare and Medicaid revenue.
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