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NPI 1891071072 · St. Charles, MO · Ambulatory Surgical Clinic/Center
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St. Charles Surgery Center is a ambulatory surgical clinic/center provider located in St. Charles, Missouri. This profile covers 12 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 | St. Charles Surgery Center |
| Address | 3501 Harry S. Truman Blvd. |
| City | St. Charles |
| State | MO |
| ZIP | 63301 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | November 1, 2011 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.3M |
| Medicaid | $60.8K |
Billing mix and taxonomy point to an ophthalmic ambulatory surgical center: the top Medicare codes are 66984 (intraocular lens insertion after extracapsular cataract extraction), 66821 (laser capsulotomy for secondary membranous cataract), and J1097 (phenylephrine/ketorolac ophthalmic irrigation), which together indicate the facility primarily performs cataract and anterior-segment eye procedures in an ASC setting. This procedural concentration aligns with the listed taxonomy Ambulatory Surgical Clinic/Center and the clinic’s code mix.
Medicare revenue is concentrated in a very small set of ophthalmic codes: total Medicare revenue is $1.3M and the provider’s top 3 Medicare codes account for 78.7% of that Medicare revenue, led by 66984 at 63.1% of Medicare receipts. This concentration indicates that cataract surgery (and its immediate ancillary services) is the principal Medicare revenue driver for the site.
Medicaid billing is effectively single-procedure focused: total Medicaid revenue is $60.8K and 66984 accounts for 100.0% of Medicaid revenue (471 claims). The provider’s Medicaid activity is therefore narrowly centered on cataract extraction and lens insertion without appreciable Medicaid revenue from other procedure lines.
Payer mix is heavily Medicare-dominant in scale: Medicare revenue ($1.3M) dwarfs Medicaid revenue ($60.8K), so public-payer exposure is overwhelmingly through Medicare and Medicaid represents a small fraction of reported public-payer billing. This imbalance implies revenue sensitivity primarily to Medicare reimbursement and volume trends.
Competitive standing varies by procedure: for 66984 the provider ranks #1932 of 15965 nationally (88th percentile) on Medicare, described as a typical, unremarkable volume despite the high share of revenue it represents; by contrast 66821 ranks #201 of 10087 (98th percentile) and is explicitly noted as notably above typical national volume, indicating relatively stronger market positioning for posterior capsulotomy compared with peers. J1097 ranks #203 of 443 (54th percentile), reflecting a typical volume position for the ophthalmic irrigation product.
The same cataract procedure shows a large payer-rate differential: average paid/claim for 66984 is $817 on Medicare versus $129 on Medicaid as reported, which will materially affect revenue per case depending on payer mix and suggests different reimbursement dynamics across payers for identical procedures. This spread should be considered when modeling per-case margins and negotiating payer contracts.
Established tenure supports operational stability: the NPI was enumerated 2011-11-01 (~15 years ago), indicating the facility has been active for over a decade. Combined with a tightly concentrated cataract-centric case mix, this tenure suggests a stable, specialized ASC rather than a nascent or transient operation.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
12 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… | 1,040 | $820 | $848.9K |
| 66821 | The provider removes the haziness from the capsule of the eye using a laser for a patient with a secondary membranous cataract. | 530 | $200 | $105.7K |
| J1097 | phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml | 1,360 | $80 | $103.4K |
| 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 | $2,500 | $65K |
| 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 | $810 | $62.9K |
| 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… | 100 | $500 | $50.7K |
| 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. | 40 | $1,270 | $49.6K |
| J2403 | Chloroprocaine hcl ophthalmic, 3% gel, 1 mg | 20,800 | $1 | $20.8K |
| 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… | 30 | $610 | $19.5K |
| J1096 | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg | 80 | $100 | $8K |
Showing 1–10 of 12
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 12 CPT/HCPCS codes.
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Full comparison — all codes billed, vs. state median
12 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J1097 | 5 | 10 | 1,360 | $80 | $106.4K |
| J1096 | 9 | 10 | 520 | $100 | $81.6K |
| 66984 | 13 | 420 | 50 | $390 | $74K |
| 66991 | 23 | 30 | 30 | $1,230 | $55.5K |
| J2403 | 9 | 10 | 82,800 | $1 | $55K |
| 65820 | 13 | 40 | 30 | $790 | $29.1K |
| 15823 | 5 | 40 | 40 | $530 | $28.6K |
| 66982 | 10 | 80 | 20 | $610 | $22.5K |
| 66821 | 4 | 220 | 50 | $210 | $21.2K |
| 14060 | 39 | 40 | 20 | $550 | $18.1K |
Showing 1–10 of 12
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 |
|---|---|---|---|---|
| 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… | 470 | $130 | $60.8K |
How this provider's Medicaid billing volume and revenue compare to other Missouri providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Missouri median
1 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average 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… | 6 | 60 | 80 | $280 | $53.5K |
Other providers in the same ZIP code as St. Charles Surgery Center, ranked by combined Medicare and Medicaid revenue.
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