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NPI 1831182799 · St George, UT · Ambulatory Surgical Clinic/Center
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Zion Eye Institute, Inc is a ambulatory surgical clinic/center provider located in St George, Utah. This profile covers 17 Medicare and 1 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 | Zion Eye Institute, Inc |
| Address | 1791 E 280 N |
| City | St George |
| State | UT |
| ZIP | 84790 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | August 25, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $6.1M |
| Medicaid | $19.7K |
ZION EYE INSTITUTE, INC is operating as an ambulatory surgical clinic with a mixed procedural profile that is heavily weighted toward interventional spinal and pain procedures alongside outpatient ophthalmic surgery. Its Medicare top billings include spinal neurostimulator and related spinal procedures (63685, 63655, 63650) and a high-volume cataract code (66984), indicating the facility supports both device-based spine interventions and routine ophthalmic surgical care in an outpatient setting.
Medicare revenue is highly concentrated: the precomputed top 3 Medicare codes account for 65.3% of the provider's total Medicare revenue. Specifically, 63685 generates $2.4M (39.3% of Medicare revenue), 64628 generates $828.3K (13.5%), and 63655 generates $768.2K (12.5%), showing most Medicare dollars come from a small set of device- and procedure-heavy spinal services.
The provider is a national outlier on multiple spine-related Medicare codes, suggesting a specialty emphasis or referral pattern for these services. 63685 ranks #4 of 1281 providers nationally (100th percentile, extreme outlier), 64628 ranks #1 of 247 (100th percentile, extreme outlier), and 63655 ranks #2 of 245 (100th percentile, extreme outlier), signifying volumes far above typical national peers for those specific procedures.
Beyond the extreme outliers, ZION EYE INSTITUTE posts notably above-typical national volume for other spine and related procedures as well: 63650 ranks #56 of 1371 (96th percentile; notably above typical) and 27279 ranks #7 of 161 (96th percentile; notably above typical). Conversely, routine ophthalmology codes such as 66984 (717 claims, $594.4K, 9.7% of Medicare revenue) fall in a more typical national range (85th percentile), indicating a mixed business model with both high-concentration specialty services and standard outpatient eye surgery.
Payer mix is effectively single-payer dominated by Medicare in scale: lifetime Medicare revenue is $6.1M versus lifetime Medicaid revenue of $19.7K, so Medicaid represents a vanishingly small portion of the revenue base. The Medicaid footprint is narrowly focused — the single reported Medicaid code is 41899 (26 claims, $19.7K), which accounts for 100.0% of this provider's Medicaid revenue and indicates minimal Medicaid activity overall.
The Medicaid competitive standing is modest in-state: 41899 ranks #20 of 23 providers in Utah (14th percentile), suggesting the provider is a minor Medicaid participant for the unspecified dental/adjacent-alveolar code. This contrasts sharply with the provider's national dominance on several spine-related Medicare procedures, underlining divergent competitive positions across payers and service lines.
The combination of high Medicare concentration in a few, device-heavy spinal codes and long tenure supports the interpretation of an established, specialized outpatient spine/pain program. The NPI was enumerated on 2005-08-25 (~21 years ago), consistent with an experienced facility that has had time to develop referral streams and procedural volume in these niche services.
Concentration and outlier status create business implications for payers: with 65.3% of Medicare revenue tied to three high-cost spinal/device codes and multiple codes labeled as "extreme outlier" or "notably above typical," utilization management, network strategy, and reimbursement benchmarking should focus on these specific services (e.g., 63685, 64628, 63655). Given the negligible Medicaid revenue and low in-state rank on the sole Medicaid code, Medicaid policy or contracting changes are unlikely to materially affect this provider's overall revenue profile.
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 |
|---|---|---|---|---|
| 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… | 130 | $18,560 | $2.4M |
| 64628 | The provider uses a thermal (heat) method under imaging guidance to destroy an intraosseous basivertebral nerve. Use this code for the first two lumbar or sacral vertebral bodies treated at a session. | 110 | $7,530 | $828.3K |
| 63655 | In this procedure, the provider removes a portion of the vertebra called the lamina and places a permanent plate/paddle electrode in the epidural space, or area between the dura membrane and the wall… | 60 | $13,250 | $768.2K |
| 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… | 720 | $830 | $594.4K |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 160 | $3,670 | $590.5K |
| 27279 | The provider performs sacroiliac (SI) joint fusion using a percutaneous or minimally invasive approach. The SI joint is where the sacrum (the base of the spine) meets the ilium (part of the pelvic… | 40 | $13,030 | $469.1K |
| 22612 | The provider performs arthrodesis, also known as spinal fusion, in the lumbar spine (lower back), to permanently join two vertebrae, the interlocking bones of the spine. The provider applies bone… | 10 | $12,130 | $169.9K |
| 64555 | A neurostimulator includes electrodes which are inserted under the skin and induced by a generator to stimulate the nerve tissue. Use of this stimulator involves implantation of electrodes around a… | 20 | $4,270 | $85.4K |
| 63047 | The provider performs a laminectomy (excision of the thin bony plate at the back of a vertebra), facetectomy (excision of an area of a vertebra characterized by its smooth surface), and foraminotomy… | 20 | $1,930 | $40.5K |
| 67917 | During this procedure, the provider performs an extensive repair of an ectropion, which is an outward turning of the lower eyelid and eyelashes, which can lead to excessive tearing and irritation of… | 60 | $560 | $35.5K |
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 |
|---|---|---|---|---|---|
| 63655 | 1 | 10 | 40 | $4,920 | $201.7K |
| 63685 | 1 | 20 | 20 | $6,650 | $192.7K |
| 27279 | 1 | 10 | 30 | $5,120 | $163.9K |
| 63650 | 3 | 20 | 50 | $1,750 | $124.6K |
| 64628 | 1 | 20 | 20 | $3,880 | $93.1K |
| 66984 | 5 | 150 | 90 | $520 | $80.3K |
| 64555 | 1 | 10 | 20 | $2,890 | $54.9K |
| 67904 | 6 | 10 | 40 | $530 | $32K |
| 22612 | 16 | 30 | 20 | $1,050 | $25.2K |
| 66982 | 17 | 50 | 30 | $620 | $22.2K |
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.
1 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. | 30 | $760 | $19.7K |
How this provider's Medicaid billing volume and revenue compare to other Utah providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Utah median
1 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. | 20 | 20 | 630 | $750 | $1.2M |
Other providers in the same ZIP code as Zion Eye Institute, Inc, ranked by combined Medicare and Medicaid revenue.
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