Loading...
NPI 1912097700 · Lexington, KY · Ambulatory Surgical Clinic/Center
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
New Lexington Clinic, Psc is a ambulatory surgical clinic/center provider located in Lexington, Kentucky. This profile covers 27 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 | New Lexington Clinic, Psc |
| Address | 1225 S Broadway |
| City | Lexington |
| State | KY |
| ZIP | 40504 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | October 13, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $1.6M |
| Medicaid | $148.3K |
NEW LEXINGTON CLINIC, PSC is an ambulatory surgical clinic by taxonomy and its Medicare top codes indicate a mixed procedural focus on interventional pain/spine procedures and endoscopy; high-revenue Medicare codes include spinal neurostimulator implantation (63685) and epidural electrode placement (63650) alongside colonoscopy/EGD-related codes (45385, 45380, 43239), suggesting the clinic operates both pain-management/spinal services and GI endoscopy suites.
Medicare revenue scale is substantially larger than Medicaid for this provider: Total Medicare revenue is $1.6M versus total Medicaid revenue of $148.3K, indicating Medicare is the dominant payer for this clinic’s billed services and that Medicaid contributes a relatively small share of lifetime revenue.
Revenue concentration differs by payer: precomputed metrics show the provider’s top 3 Medicare codes account for 43.7% of Medicare revenue, reflecting a moderate concentration of Medicare income in a few high-value procedures, while the top 3 Medicaid codes account for 99.4% of Medicaid revenue, indicating Medicaid billing is almost entirely concentrated in a very small set of services.
On Medicare the clinic is a notable volume outlier for several endoscopy and pain codes: 45385 and 45380 both rank in the 97th percentile nationally (described as notably above typical national volume), 43239 is also 97th percentile, and several pain-related injections (64493, 62323, 64635) are in the high percentiles or labeled extreme outlier, which together indicate above-typical procedure volumes in both GI and interventional pain compared with national peers.
Competitive standing is mixed by code: for Medicare the clinic’s 63685 revenue ranks #662 of 1281 (42nd percentile) indicating typical, unremarkable national volume for that implant code, whereas codes like 63650 (75th percentile) and 45385/45380/43239 (97th percentile) show stronger relative volume and suggest local competitiveness in endoscopy and certain pain procedures rather than dominance in high-tech implant work.
Medicaid billing is heavily concentrated in a single procedure on the state roster: 43239 accounts for $134.4K or 90.8% of Medicaid revenue and ranks #115 of 174 in-state (34th percentile), indicating the clinic bills a large absolute number of Medicaid EGDs for biopsy but is not a statewide leader in that code by percentile ranking.
Tenure is long enough to establish an operational footprint: the NPI was enumerated on 2006-10-13 (~20 years ago), which supports interpretation of these patterns as established practice patterns rather than brief or nascent activity.
The payer-code mix suggests operational implications for capacity and resource planning: strong Medicare volumes in both endoscopy (high claim counts for 45385, 45380, 43239) and interventional pain (multiple high-percentile injection and neurostimulator codes) imply the clinic maintains both endoscopy suites and fluoroscopy-guided pain/injection capability, and would need staffing/models that support episodic procedures, pathology workflow, and device/implant case coordination.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
27 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… | 20 | $18,290 | $292.6K |
| 63650 | In this procedure, the provider places electrodes in the epidural space to relieve pain and reduce or eliminate spasms. | 70 | $3,540 | $247.4K |
| 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… | 340 | $430 | $146.7K |
| 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… | 370 | $350 | $128.4K |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 270 | $380 | $103.3K |
| 64635 | Under fluoroscopic or CT guidance, the provider applies an agent to a lower back joint to destroy nerve tissue. | 210 | $480 | $98.9K |
| 64493 | The provider injects a diagnostic or therapeutic substance into a single lumbar or sacral paravertebral facet (zygapophyseal) joint, or into the nerves that supply that joint, using imaging guidance… | 360 | $250 | $87.3K |
| 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. | 360 | $220 | $78.6K |
| 62323 | The provider injects a diagnostic or a therapeutic substance, such as pain medication or a steroid, into the space around the spinal nerves of the lumbar (lower back) or sacral (caudal, or tailbone)… | 290 | $240 | $69.3K |
| 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). | 160 | $290 | $45.7K |
Showing 1–10 of 27
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 27 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
27 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 63685 | 5 | 20 | 20 | $6,870 | $116.9K |
| 63650 | 4 | 20 | 50 | $1,620 | $81K |
| J3304 | 16 | 30 | 1,570 | $10 | $29.3K |
| G0260 | 2 | 10 | 80 | $200 | $26.7K |
| 64635 | 3 | 90 | 40 | $390 | $23.5K |
| 45385 | 5 | 250 | 50 | $250 | $20.2K |
| 64483 | 15 | 80 | 50 | $180 | $17.7K |
| 62323 | 11 | 120 | 80 | $130 | $15K |
| 19301 | 14 | 20 | 30 | $510 | $13.7K |
| 64493 | 2 | 100 | 60 | $160 | $13K |
Showing 1–10 of 27
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. | 670 | $200 | $134.4K |
| 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… | 40 | $250 | $10.7K |
| 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… | 10 | $160 | $2.2K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 30 | $30 | $830 |
| 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… | 70 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Kentucky providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Kentucky 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. | 115 | 170 | 1,300 | $230 | $441K |
| 88305 | The physician, typically a pathologist, performs a level IV examination of a surgical pathology specimen. The examination includes accessioning the specimen into the lab, which involves formally… | 122 | 130 | 2,450 | $60 | $382.4K |
| 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… | 101 | 120 | 300 | $320 | $215.2K |
| 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… | 94 | 110 | 230 | $340 | $175.7K |
| 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… | 18 | 20 | 260 | $1 | $1 |
Other providers in the same ZIP code as New Lexington Clinic, Psc, 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.