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NPI 1871538694 · Albuquerque, NM · Ambulatory Surgical Clinic/Center
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Southwest Endoscopy Ltd is a ambulatory surgical clinic/center provider located in Albuquerque, New Mexico. This profile covers 13 Medicare and 5 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 | Southwest Endoscopy Ltd |
| Address | 7788 Jefferson St Ne |
| City | Albuquerque |
| State | NM |
| ZIP | 87109 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | June 17, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $1.6M |
| Medicare | $1.2M |
Service-line profile: SOUTHWEST ENDOSCOPY LTD’s billed procedures are concentrated in gastrointestinal endoscopy consistent with an ambulatory endoscopy center, with the leading Medicare revenue codes being 45380 (biopsy colonoscopy), 45385 (colonoscopic polypectomy), and 43239 (EGD with biopsy). The presence of screening codes G0105 and G0121 on the Medicare side further indicates a mix of diagnostic, screening, and therapeutic colonoscopy services offered onsite rather than a broad multispecialty surgical mix.
Medicare revenue concentration: Precomputed top 3 Medicare codes account for 77.5% of this provider's total Medicare revenue, driven by 45380 ($446.3K, 36.2%), 45385 ($324.5K, 26.3%), and 43239 ($186.3K, 15.1%). This concentration shows heavy dependence on a narrow set of colonoscopy/EGD procedures for Medicare dollars, which concentrates operational and payer risk around these GI services.
Medicaid revenue concentration: Precomputed top 3 Medicaid codes account for 99.1% of this provider's total Medicaid revenue, with 43239 ($791.6K, 48.8%), 45380 ($610.2K, 37.6%), and 45385 ($206.1K, 12.7%) comprising nearly the entire Medicaid topline. Medicaid payments are therefore almost entirely driven by the same endoscopy suite procedures that dominate Medicare revenue, implying similar clinical throughput and coding mix across payers.
Payer mix and scale: This provider reports $1.2M in lifetime Medicare revenue and $1.6M in lifetime Medicaid revenue, indicating Medicaid is the larger single payer in scale for this entity but that both public payers materially contribute to overall volume. The difference in absolute dollars shows it is not single-payer-dependent, yet both payers primarily reimburse the same narrow set of GI procedure codes.
National competitive standing (Medicare): For its highest-revenue Medicare codes SOUTHWEST ENDOSCOPY LTD ranks well above typical national peers—45380 ranks #15 of 16427 (100th percentile; extreme outlier), 45385 ranks #137 of 16310 (99th percentile; extreme outlier), and 43239 ranks #71 of 17140 (100th percentile; extreme outlier). These rankings signal the provider is a national high-volume outlier for core colonoscopy and EGD procedures relative to other Medicare-billing providers.
State competitive standing (Medicaid): In-state Medicaid ranks are elevated but within expected ranges: 43239 is #9 of 53 (85th percentile), 45380 is #5 of 28 (85th percentile), and 45385 is #7 of 16 (60th percentile). This indicates a strong regional presence for endoscopy services in New Mexico without the same degree of national outlier status seen in Medicare.
Operational nuance and coding pattern: While the top endoscopy codes are extreme outliers on Medicare, several secondary Medicare codes (for example 43249 at the 87th percentile, 45378 at the 94th percentile, and others in the 80–95th percentile range) sit at typical to above-typical volumes rather than extreme outlier status. This pattern suggests a focused high-throughput endoscopy operation concentrated on a small number of high-revenue procedures rather than unusually broad or diverse billing across many different CPTs.
Tenure and stability: The provider’s NPI was enumerated on 2006-06-17 (~20 years ago), indicating an established ambulatory surgical/endoscopy presence in Albuquerque with a long operational history that aligns with sustained volume in colonoscopy and EGD services across public payers.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
13 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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… | 1,220 | $370 | $446.3K |
| 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… | 760 | $430 | $324.5K |
| 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. | 840 | $220 | $186.3K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 290 | $390 | $111.4K |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 130 | $380 | $50.4K |
| 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. | 60 | $540 | $31K |
| 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… | 80 | $290 | $21.9K |
| 43248 | The provider inserts a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum; then through the scope, he passes a guidewire over which he passes dilators through the… | 60 | $240 | $15.4K |
| 43235 | The provider inserts an endoscope through the mouth and down into the esophagus, stomach, and duodenum for diagnostic purposes; the provider may collect specimens by brushing or washing. | 60 | $240 | $14.3K |
| 43251 | An esophagogastroduodenoscopy is a procedure to view the esophagus, stomach, and duodenum by means of flexible endoscope through the mouth. The physician removes one or more lesions using a snare… | 20 | $570 | $11.9K |
Showing 1–10 of 13
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 13 CPT/HCPCS codes.
View: State1 / 2
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.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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. | 3,340 | $240 | $791.6K |
| 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… | 2,410 | $250 | $610.2K |
| 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… | 770 | $270 | $206.1K |
| 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… | 50 | $300 | $14.2K |
| 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… | 80 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other New Mexico providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. New Mexico median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 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. | 9 | 50 | 300 | $260 | $436.4K |
| 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… | 5 | 30 | 420 | $320 | $352.7K |
| 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… | 7 | 20 | 490 | $330 | $292.2K |
| 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… | 18 | 30 | 70 | $330 | $122K |
| 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 | 210 | $1 | $40 |
Other providers in the same ZIP code as Southwest Endoscopy Ltd, ranked by combined Medicare and Medicaid revenue.
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