Loading...
NPI 1841275211 · Helena, MT · Ambulatory Surgical Clinic/Center
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Helena Surgicenter, LLC is a ambulatory surgical clinic/center provider located in Helena, Montana. This profile covers 18 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 | Helena Surgicenter, LLC |
| Address | 2440 Winne Ave |
| City | Helena |
| State | MT |
| ZIP | 59601 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | December 8, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1M |
| Medicaid | $160K |
Overall revenue and payer mix are heavily Medicare-weighted: the provider reports Total Medicare revenue of $1M versus Total Medicaid revenue of $160K, so Medicare is the dominant source of billed revenue while Medicaid represents a much smaller portion of activity. This indicates the facility operates primarily as a Medicare-serving ambulatory surgical center with a smaller Medicaid dental/rehabilitation footprint.
Medicare service-line focus is concentrated in ophthalmic surgery with ancillary orthopedics: code 66984 accounts for $518.4K (50.8% of this provider's total Medicare revenue) and is the single largest Medicare revenue driver, suggesting cataract extraction and intraocular lens services are the core procedure type billed. Secondary Medicare volumes include 27447 ($113.9K, 11.2%) and 23430 ($83K, 8.1%), indicating some joint replacement/orthopedic and tendon-repair procedures are performed but at much lower revenue share.
Medicare revenue concentration is high: the precomputed top 3 Medicare codes by revenue account for 70.2% of this provider's total Medicare revenue, signaling dependency on a very small set of high-revenue procedures—chiefly 66984—so changes in cataract case volume or reimbursement would materially affect overall Medicare revenue. This concentration aligns with an ambulatory surgical center model that prioritizes a limited number of high-throughput procedures.
Medicaid activity is narrowly specialized in dental procedures requiring monitored anesthesia: code 41899 contributes $112.5K (70.3% of Medicaid revenue) and G0330 contributes $47.5K (29.7%), and the precomputed top-3 share for Medicaid is 100.0% of Medicaid revenue. This indicates Medicaid billing is essentially entirely composed of dental procedures and facility services for dental rehabilitation under monitored anesthesia, consistent with state Medicaid coverage patterns for dental care requiring an operating suite.
Competitive standing for the provider's leading Medicare ophthalmology codes is comparatively strong: 66984 ranks #2458 of 15965 providers nationally (85th percentile; typical, unremarkable volume for this code) and 66982 ranks #415 of 4580 providers nationally (91th percentile; typical, unremarkable volume for this code), which together show above-average national placement on cataract-related procedures even though the narrative labels them as typical. By contrast, the provider’s orthopedic joint replacement code 27447 ranks #9567 of 12089 (18th percentile; typical, unremarkable volume for this code), indicating modest participation in high-revenue knee arthroplasty relative to national peers.
Medicaid competitive position is limited in-state: 41899 ranks #6 of 7 providers in-state (17th percentile; typical, unremarkable volume for this code) and G0330 ranks #3 of 3 providers in-state (0th percentile; typical, unremarkable volume for this code), which together suggest the facility is not a dominant in-state Medicaid dental provider and operates within a very small peer group for these services. The in-state rankings imply constrained market share for Medicaid dental facility services despite those codes comprising the entirety of Medicaid revenue.
Tenure and stability: this NPI was enumerated on 2005-12-08 (~21 years ago), indicating a long-standing presence in the market. The multi-year enumeration supports interpretations that the observed code mix and payer mix reflect an established operational model rather than a short-term fluke.
Operational/contracting note: the juxtaposition of high Medicare ophthalmic surgical revenue (dominant 66984 and related cataract codes) with Medicaid revenue concentrated exclusively in dental/anesthesia codes (41899 and G0330) suggests the facility supports distinct service lines that may require separate clinician groups, equipment, and payer-contracting approaches. Additionally, several lower-revenue Medicare codes such as C9290 ($3.8K total, 3.8K claims at $1 avg paid/claim) appear as small ancillary items and point to minor, low-paid supply or injection billing alongside the core surgical services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
18 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… | 670 | $780 | $518.4K |
| 27447 | In this procedure, the provider replaces the damaged weight bearing surfaces of both the medial and lateral compartments in the knee joint using implants of metal or other strong materials. The… | 20 | $6,700 | $113.9K |
| 23430 | In this procedure, the provider surgically cleans the long tendon of the biceps from its damaged fragment and fixes the tendon to the upper end of the humerus to improve the stability of the joint.… | 30 | $2,970 | $83K |
| 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… | 90 | $780 | $72.9K |
| 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 | $2,360 | $58.9K |
| 29827 | The provider examines the tissue inside the shoulder joint with an arthroscope. She inserts additional instruments to repair a torn rotator cuff, the grouping of muscles and tendons that surround and… | 20 | $1,380 | $30.4K |
| 15823 | In this procedure, the provider surgically trims excessive skin that weighs down the upper eyelid, typically to improve the cosmetic appearance of the face and due to the interference of the tissue… | 70 | $430 | $28.1K |
| 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… | 70 | $340 | $22.4K |
| 58558 | The provider either biopsies the lining of the uterus (endometrium) or removes polyps, or both, through a hysteroscope ; he may or may not perform a dilation and curettage (D&C). He sends all samples… | 20 | $1,030 | $18.4K |
| 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… | 40 | $380 | $14.2K |
Showing 1–10 of 18
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 18 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
18 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 66991 | 11 | 10 | 50 | $1,370 | $79.5K |
| 66984 | 7 | 120 | 50 | $490 | $78.1K |
| 27447 | 64 | 80 | 40 | $1,080 | $60.6K |
| 66982 | 4 | 30 | 30 | $600 | $29.6K |
| 45385 | 30 | 40 | 100 | $240 | $27.4K |
| 29827 | 17 | 30 | 20 | $860 | $26.7K |
| 15823 | 3 | 10 | 30 | $510 | $23.6K |
| 64721 | 22 | 20 | 60 | $400 | $20.5K |
| 23430 | 2 | 20 | 10 | $1,230 | $18.5K |
| C9290 | 4 | 10 | 13,300 | $1 | $16.4K |
Showing 1–10 of 18
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 |
|---|---|---|---|---|
| 41899 | Use this code to report a procedure on the teeth and adjoining alveolar structures for which there is no specific code available. | 70 | $1,660 | $112.5K |
| G0330 | Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an… | 40 | $1,250 | $47.5K |
| C1713 | Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) | 10 | $0 | $0 |
| 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… | 20 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Montana providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Montana median
4 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. | 6 | 10 | 210 | $1,680 | $959.9K |
| G0330 | Facility services for dental rehabilitation procedure(s) performed on a patient who requires monitored anesthesia (e.g., general, intravenous sedation (monitored anesthesia care) and use of an… | 3 | 10 | 300 | $1,760 | $373.4K |
| C1713 | Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) | 12 | 10 | 540 | $50 | $29.1K |
| 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… | 9 | 10 | 140 | $0 | $0 |
Other providers in the same ZIP code as Helena Surgicenter, LLC, ranked by combined Medicare and Medicaid revenue.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.