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NPI 1720143779 · Somerset, KY · Ambulatory Surgical Clinic/Center
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Lake Cumberland Surgery Center LP is a ambulatory surgical clinic/center provider located in Somerset, Kentucky. This profile covers 17 Medicare and 14 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 | Lake Cumberland Surgery Center LP |
| Address | 301 Langdon St |
| City | Somerset |
| State | KY |
| ZIP | 42503 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | December 27, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $8.7M |
| Medicare | $1M |
This facility’s billing mix indicates a mixed ambulatory surgical clinic emphasis on ophthalmology and GI endoscopy with a very large dental-coded volume in Medicaid. On the Medicare side the single largest line is cataract extraction with intraocular lens/related procedures (66984) generating $482.6K in revenue (48.0% of this provider's total Medicare revenue), and several endoscopy codes (43249, 43239, 45385, 45380) together contribute meaningful Medicare revenue. On the Medicaid side a single generic dental procedure code, 41899, dominates with $5.5M in revenue (63.5% of this provider's total Medicaid revenue), indicating that dental or oral procedures billed under an unspecified dental code are a primary Medicaid service line.
Revenue concentration is high for both payers. Precomputed totals show the top 3 Medicare codes by revenue account for 63.6% of Medicare revenue, while the top 3 Medicaid codes by revenue account for 84.5% of Medicaid revenue, signaling reliance on a narrow set of procedures to drive most collections.
Payer mix is heavily skewed toward Medicaid at this provider. Reported lifetime revenue is $1M from Medicare versus $8.7M from Medicaid, indicating Medicaid accounts for the majority of billed revenue and the center functions effectively as a Medicaid-dominant ambulatory surgical center.
Competitive standing differs by code and payer: the provider is a statewide outlier for certain Medicaid dental activity but more modest nationally for typical ophthalmology volume. For Medicaid 41899 ranks #1 of 42 providers in-state (100th percentile; extreme outlier), while Medicaid 66984 ranks #7 of 71 in-state (91st percentile; notably above typical state volume). For Medicare 66984 ranks #2534 of 15965 (84th percentile; typical, unremarkable volume), but Medicare 43249 ranks #64 of 3500 (98th percentile; notably above typical national volume) and Medicare 43239 ranks #804 of 17140 (95th percentile; notably above typical national volume).
Operational implication: the combination of high-volume cataract procedures (66984 and related cataract codes) and frequent upper-GI endoscopy/biopsy work (43249, 43239) suggests the center supports both ophthalmology and gastroenterology procedural workflows, with staffing and equipment oriented to same-day surgical and endoscopic care. The Medicaid-dominant dental coding (41899) implies substantial resources or contracting directed to oral/maxillofacial or dental surgical cases under Medicaid billing.
Statistical outlier note: the provider’s Medicaid activity for 41899 is labeled an "extreme outlier" and indeed represents $5.5M (63.5% of Medicaid revenue) and the #1 in-state rank; this single code is an outsized driver of Medicaid revenue compared with most peers. Several Medicare GI codes are characterized as "notably above typical" in national percentile ranks (43249 at the 98th percentile; 43239 at the 95th percentile), indicating specialty-focused endoscopy throughput above the national norm.
Service-line risk and opportunity: heavy concentration in a few codes creates operational sensitivity to reimbursement or utilization shifts in those specific CPT/HCPCS codes. Given the precomputed concentration metrics (top 3 Medicare = 63.6% and top 3 Medicaid = 84.5%), payers and provider analysts should flag these codes (notably 41899, 66984, and the high-volume endoscopy codes) for detailed utilization review, contracting focus, and capacity planning.
Tenure and stability: the provider’s NPI was enumerated on 2006-12-27 (~20 years ago), indicating long-standing enrollment and multi-year operating history in the market, which supports interpreting these patterns as established practice lines rather than transient activity.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
17 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… | 640 | $760 | $482.6K |
| 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… | 230 | $380 | $88.3K |
| 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. | 130 | $530 | $67.7K |
| 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… | 190 | $310 | $57.9K |
| C9740 | Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants | 10 | $4,730 | $52.1K |
| 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. | 290 | $170 | $49.8K |
| 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 | $2,250 | $47.2K |
| 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… | 50 | $760 | $36.7K |
| 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. | 30 | $960 | $25.9K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 100 | $190 | $19.3K |
Showing 1–10 of 17
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 17 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
17 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| C9740 | 4 | 10 | 40 | $5,180 | $155.3K |
| 66984 | 199 | 310 | 1,560 | $40 | $67.1K |
| 66991 | 11 | 10 | 30 | $1,390 | $43K |
| 65820 | 5 | 10 | 30 | $890 | $24.8K |
| 15823 | 11 | 20 | 30 | $550 | $21.6K |
| 66982 | 23 | 70 | 30 | $270 | $20.8K |
| 45385 | 13 | 250 | 50 | $250 | $20.2K |
| 66821 | 44 | 160 | 50 | $110 | $16.1K |
| 64721 | 38 | 40 | 20 | $360 | $11.8K |
| 45380 | 14 | 240 | 40 | $140 | $9.4K |
Showing 1–10 of 17
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.
14 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. | 6,860 | $810 | $5.5M |
| 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… | 3,460 | $360 | $1.2M |
| 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. | 3,960 | $150 | $610K |
| 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… | 1,890 | $210 | $396.1K |
| 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… | 1,860 | $190 | $345.8K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 190 | $1,030 | $195.7K |
| 45378 | The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush… | 610 | $240 | $146.5K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 490 | $290 | $142.5K |
| 41874 | Alveoloplasty is done prior to placement of a dental prosthesis. In order to facilitate smooth fitting of the denture, the dentist performs alveoloplasty to make the alveolar process smoother.… | 60 | $770 | $44.5K |
| 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. | 290 | $150 | $44.2K |
Showing 1–10 of 14
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
14 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. | 1 | 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. | 28 | 170 | 1,300 | $230 | $441K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 24 | 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… | 7 | 70 | 210 | $310 | $290K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 24 | 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… | 17 | 120 | 300 | $320 | $215.2K |
| L8699 | Prosthetic implant, not otherwise specified | 7 | 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… | 6 | 110 | 230 | $340 | $175.7K |
| 45378 | The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush… | 17 | 90 | 170 | $400 | $145.8K |
| 41874 | Alveoloplasty is done prior to placement of a dental prosthesis. In order to facilitate smooth fitting of the denture, the dentist performs alveoloplasty to make the alveolar process smoother.… | 2 | 10 | 60 | $1,150 | $88.5K |
Showing 1–10 of 14
Other providers in the same ZIP code as Lake Cumberland Surgery Center LP, ranked by combined Medicare and Medicaid revenue.
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