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NPI 1750343083 · Lexington, KY · Ambulatory Surgical Clinic/Center
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Lexington Surgery Center Ltd is a ambulatory surgical clinic/center provider located in Lexington, Kentucky. This profile covers 19 Medicare and 16 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 | Lexington Surgery Center Ltd |
| Address | 2115 Harrodsburg Rd |
| City | Lexington |
| State | KY |
| ZIP | 40504 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | April 3, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $5.4M |
| Medicare | $1.3M |
LEXINGTON SURGERY CENTER LTD reports $1.3M in lifetime Medicare revenue versus $5.4M in lifetime Medicaid revenue, indicating a Medicaid-dominant payer mix where Medicaid receipts are materially larger than Medicare receipts. This scale difference suggests the facility’s case mix and financial exposure are driven primarily by state Medicaid volumes rather than Medicare fee-for-service.
The provider’s CPT mix is concentrated in ophthalmology and pediatric/ENT procedures with ancillary device work and some spinal neuromodulation. High-revenue ophthalmic codes such as 66984, 66982 and 66821 appear on the Medicare and Medicaid lists, while Medicaid billing is also driven by pediatric ENT and airway procedures (for example 69436, 42820, 42830), plus implant/device codes (L8699, V2632) and limited spine neurostimulator placement (63685, 63650). This pattern is consistent with an ambulatory surgical center that runs both adult ophthalmic cataract cases and high-volume pediatric ENT/implant sessions.
Revenue concentration is high for both payers: the top three Medicare codes account for 65.7% of this provider’s Medicare revenue and the top three Medicaid codes account for 69.0% of its Medicaid revenue. For Medicare the dominant contributors are led by 66984 and include high-dollar spinal neurostimulator placement (63685) and eyelid repair (67904); for Medicaid the revenue mix centers on 66984, 69436 and L8699. That concentration implies the provider’s financial performance is sensitive to volume or reimbursement shifts in a small set of procedures.
On Medicare competitive standing, the provider generates a large share of its Medicare revenue from 66984 (38.0% of Medicare revenue) and ranks #2579 of 15965 nationally (84th percentile) for that code, which the data characterizes as typical, unremarkable volume at the national scale. The provider also has a relatively high national percentile for 67904 (rank #82 of 991, 92nd percentile) indicating stronger relative volume for certain eyelid repairs, while its spinal generator code 63685 sits at a more modest national position (rank #741 of 1281, 36th percentile). Overall, the Medicare footprint looks specialized—not a dominant national center but with pockets of above-average activity in selected ophthalmic procedures.
On Medicaid competitive standing within Kentucky, the provider is a major in specific service lines: 69436 (tympanostomy with tube) is listed as rank #3 of 77 in-state (97th percentile; extreme outlier), and L8699 (prosthetic implant, NOS) is rank #1 of 8 (100th percentile; notably above typical state volume). 66984 also ranks high in-state (rank #10 of 71, 87th percentile). These state-level positions indicate the facility is a prominent local provider for pediatric ENT procedures and certain implantable-device billing, making it a meaningful in-state competitor for those services.
The NPI was enumerated on 2006-04-03 (~20 years ago), indicating the center has an established operating history in the market. That tenure, combined with concentrated high-volume pediatric and ophthalmic lines, suggests established referral relationships for both cataract and pediatric ENT cases rather than a recent or experimental service expansion.
Medicaid data include several entries with $0 average paid (for example G8918, G8907 and C1889), which appear as documented claims or encounter-level records without associated paid revenue. These zero-paid lines likely reflect administrative, quality-reporting, or device-classification codes rather than revenue-generating procedures, and they should be treated as non-revenue items when modeling net reimbursement.
Operational and payer-negotiation implication: the combination of very high in-state ranking for pediatric tympanostomy (69436) and dominant Medicaid volumes ($5.4M total Medicaid revenue) suggests the center’s leverage and risk profile will be most relevant to state Medicaid programs and pediatric-focused networks. Simultaneously, sustained cataract volume across both payers (66984 appears prominently on Medicare and Medicaid lists) provides a stable, cross-payer procedural base that payers and competitors should consider when assessing capacity and referral alignment.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
19 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… | 610 | $800 | $492.4K |
| 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… | 20 | $17,150 | $257.3K |
| 67904 | The provider repairs a drooping eyelid by tightening the levator muscle that controls eyelid movement to improve cosmetic appearance or remove the obstruction to a patient’s vision. He accesses the… | 110 | $940 | $102.8K |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 30 | $3,630 | $90.8K |
| V2785 | Processing, preserving and transporting corneal tissue | 20 | $3,990 | $75.8K |
| 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… | 80 | $790 | $65.6K |
| 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… | 20 | $2,210 | $35.3K |
| 65756 | During this procedure, the provider performs a complete corneal transplant to replace a damaged corneal endothelium. | 20 | $1,460 | $30.6K |
| 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. | 20 | $1,450 | $24.6K |
| 67042 | In this procedure, the provider removes vitreous humor, the gelatinous material that gives shape to the eye, using a mechanical cutting tool. He removes the internal limiting membrane of the retina… | 10 | $1,460 | $18.9K |
Showing 1–10 of 19
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 19 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
19 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 63685 | 7 | 20 | 20 | $6,870 | $116.9K |
| V2785 | 3 | 10 | 20 | $3,210 | $86.8K |
| 63650 | 15 | 20 | 50 | $1,620 | $81K |
| 66984 | 202 | 310 | 1,560 | $40 | $67.1K |
| 67904 | 2 | 10 | 40 | $690 | $38.5K |
| 67036 | 12 | 20 | 20 | $910 | $28.1K |
| 0449T | 4 | 10 | 20 | $1,270 | $27.9K |
| 65756 | 3 | 10 | 20 | $1,020 | $23.5K |
| 67042 | 11 | 10 | 20 | $1,170 | $23.4K |
| 66982 | 14 | 70 | 30 | $270 | $20.8K |
Showing 1–10 of 19
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.
16 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… | 2,670 | $550 | $1.5M |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 3,620 | $330 | $1.2M |
| L8699 | Prosthetic implant, not otherwise specified | 5,570 | $190 | $1.1M |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 740 | $1,380 | $1M |
| 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. | 1,140 | $250 | $283.2K |
| 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… | 590 | $290 | $172.6K |
| 42830 | The provider performs an initial adenoidectomy in a patient who is less than 12 years old. | 170 | $730 | $121.2K |
| 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… | 110 | $330 | $35.8K |
| 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… | 40 | $370 | $14.9K |
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 20 | $970 | $14.6K |
Showing 1–10 of 16
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
16 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. | 41 | 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. | 92 | 170 | 1,300 | $230 | $441K |
| 67311 | The provider realigns an imbalance in the eye muscles by either recession, which weakens the eye muscle or resection, which strengthens the muscles so as to restore normal vision. This procedure is… | 6 | 10 | 90 | $1,190 | $304.1K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 11 | 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… | 10 | 70 | 210 | $310 | $290K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 3 | 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… | 43 | 120 | 300 | $320 | $215.2K |
| L8699 | Prosthetic implant, not otherwise specified | 1 | 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… | 67 | 110 | 230 | $340 | $175.7K |
| C1889 | Implantable/insertable device, not otherwise classified | 18 | 20 | 270 | $220 | $172.6K |
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Other providers in the same ZIP code as Lexington Surgery Center Ltd, ranked by combined Medicare and Medicaid revenue.
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