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NPI 1902841398 · Mason City, IA · Ambulatory Surgical Clinic/Center
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Mason City Ambulatory Surgery Center, LLC is a ambulatory surgical clinic/center provider located in Mason City, Iowa. This profile covers 45 Medicare and 10 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 | Mason City Ambulatory Surgery Center, LLC |
| Address | 990 4th St Sw |
| City | Mason City |
| State | IA |
| ZIP | 50401 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | June 18, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $2.2M |
| Medicaid | $422.9K |
MASON CITY AMBULATORY SURGERY CENTER, LLC shows a clear payer-scale imbalance: lifetime Medicare revenue is $2.2M while lifetime Medicaid revenue is $422.9K, so Medicare is the substantially larger revenue source for this facility. The practice has an established presence, with its NPI enumerated on 2006-06-18 (~20 years ago), indicating long-standing participation in federal programs.
Medicare billing is concentrated in a small set of high-revenue procedure types: the precomputed top 3 Medicare codes account for 52.4% of Medicare revenue and are led by 66984 (cataract extraction with IOL), 27447 (knee arthroplasty), and 45385 (colonoscopic polypectomy). This mix suggests the ambulatory surgery center supports multiple surgical service lines — ophthalmology, orthopedics (outpatient TKA activity), and gastroenterology — and derives the majority of its Medicare earnings from those specialties.
While cataract surgery (66984) and knee arthroplasty (27447) show typical national volumes (66984 in the 86th percentile, 27447 in the 67th percentile), the provider is a national outlier for colonoscopic polypectomy: 45385 is reported as an extreme outlier (98th percentile, ranks #302 of 16310). That indicates unusually high endoscopy/polypectomy throughput relative to peers and a competitive strength in GI procedural volume on the Medicare side.
Medicaid revenue is highly concentrated in pediatric ENT procedures: the top 3 Medicaid codes account for 93.4% of Medicaid revenue, with 69436 (tympanostomy with tube) alone contributing $335.2K or 79.2% of Medicaid revenue. This pattern points to a Medicaid business line that is heavily dependent on ear tube procedures (and to a lesser extent tonsil/adenoid surgery 42820), implying the facility functions as a local site for high-volume pediatric ENT work under Medicaid.
Competitive standing in-state for the dominant Medicaid code is above typical but not singular: 69436 ranks #11 of 52 providers in-state (80th percentile), so the center is a meaningful regional provider of tympanostomy services but not the top-ranked surgical site statewide. Other Medicaid procedures such as 42820 (tonsil/adenoid, 54th percentile) and 43239 (EGD biopsy, 29th percentile) show more modest in-state positions, reinforcing that Medicaid competitive strength is concentrated and localized.
The Medicaid dataset includes a set of high-claim but zero-paid items (for example, G8907 with 403 claims and $0 revenue, L8699 with 525 claims and $0 revenue, and G8918 with 93 claims and $0 revenue). These entries materially increase reported claim counts on the Medicaid side without adding revenue, so analysts should treat raw Medicaid claim volumes cautiously and separate revenue-driving procedures from zero-dollar administrative or supply entries when assessing operational scale.
On Medicare there are notable ancillary and pharmaceutical billing patterns: C9290 appears as 22.7K claims with $22.7K revenue and ranks in the 88th percentile nationally, reflecting very frequent, low-dollar billing for bupivacaine liposome; similarly, J1097 (ophthalmic irrigation solution) accounts for 810 claims and $61.6K (3.0% of Medicare revenue). These items corroborate a high throughput of short-duration ophthalmic and ambulatory procedures that consume specific injectable and irrigation products.
From a contracting and risk perspective, the provider’s revenue concentration presents both leverage and exposure: Medicare-dominant revenues ($2.2M) driven 52.4% by three codes makes rate negotiations and capacity planning most sensitive to reimbursement changes or competitive shifts in ophthalmology, orthopedics, and GI; on the Medicaid side the business model is heavily reliant on tympanostomy/ENT volume (top 3 = 93.4%), so any policy or referral changes affecting pediatric ENT could materially affect the facility’s Medicaid revenue.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
45 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… | 780 | $750 | $579.6K |
| 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… | 50 | $6,420 | $288.7K |
| 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… | 500 | $410 | $207.4K |
| 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… | 170 | $750 | $126K |
| 66174 | The provider expands the aqueous outflow (drainage) canal of the eye to help relieve pressure in the eye. The procedure does not include leaving a device or stent in place. | 60 | $1,390 | $76.2K |
| C9740 | Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants | 10 | $5,080 | $66K |
| 52356 | The provider performs a cystourethroscopy, the inspection of the interior of the bladder, the urethra, prostatic urethra, and ureteric openings using a cystoscope passed through the urethra and into… | 40 | $1,550 | $65.1K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 170 | $380 | $62.9K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 110 | $590 | $62.3K |
| J1097 | phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml | 810 | $80 | $61.6K |
Showing 1–10 of 45
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 45 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
45 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J1097 | 3 | 10 | 810 | $80 | $149.5K |
| C9740 | 2 | 10 | 10 | $4,960 | $69.5K |
| 66984 | 19 | 340 | 50 | $340 | $50.4K |
| 66991 | 12 | 20 | 30 | $1,360 | $50.2K |
| 27447 | 78 | 190 | 40 | $870 | $41.7K |
| J0585 | 19 | 30 | 5,050 | $1 | $40.9K |
| 66982 | 11 | 60 | 40 | $450 | $39K |
| 66174 | 1 | 10 | 30 | $1,020 | $32.6K |
| 45385 | 7 | 150 | 80 | $250 | $29.6K |
| 15823 | 16 | 20 | 30 | $520 | $29.4K |
Showing 1–10 of 45
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.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 620 | $540 | $335.2K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 70 | $620 | $42.1K |
| 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. | 70 | $260 | $18K |
| 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… | 30 | $420 | $14.2K |
| 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… | 30 | $270 | $7.6K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 20 | $210 | $4.8K |
| A4649 | Surgical supply; miscellaneous | 10 | $80 | $1.1K |
| 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… | 400 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 90 | $0 | $0 |
| L8699 | Prosthetic implant, not otherwise specified | 530 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Iowa providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Iowa median
10 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… | 8 | 10 | 130 | $580 | $506.8K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 11 | 50 | 170 | $410 | $153.8K |
| 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. | 40 | 60 | 260 | $210 | $109.2K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 12 | 30 | 60 | $750 | $96.1K |
| 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… | 19 | 30 | 60 | $280 | $43.2K |
| 64483 | This procedure is the injection of an anesthetic agent and/or steroid in the form of a transforaminal epidural injection into a single level (either lumbar or sacral). | 4 | 10 | 20 | $130 | $10.7K |
| A4649 | Surgical supply; miscellaneous | 4 | 10 | 30 | $1 | $290 |
| L8699 | Prosthetic implant, not otherwise specified | 2 | 10 | 120 | $1 | $1 |
| 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… | 1 | 10 | 50 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 3 | 10 | 140 | $0 | $0 |
Other providers in the same ZIP code as Mason City Ambulatory Surgery Center, LLC, ranked by combined Medicare and Medicaid revenue.
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