Loading...
NPI 1922093293 · Lewiston, ID · Ambulatory Surgical Clinic/Center
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Lewis & Clark Orthopaedic Institute LLC is a ambulatory surgical clinic/center provider located in Lewiston, Idaho. This profile covers 20 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 | Lewis & Clark Orthopaedic Institute LLC |
| Address | 318 Warner Dr |
| City | Lewiston |
| State | ID |
| ZIP | 83501 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | September 13, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $595.9K |
| Medicaid | $103.4K |
LEWIS & CLARK ORTHOPAEDIC INSTITUTE LLC operates as an ambulatory surgical clinic/center and the Medicare code mix (27447, 23430, 64721 plus multiple arthroscopy and hand procedure codes such as 29880, 29881, 26055, 26480) indicates a primary focus on orthopedic and hand/upper-extremity surgical procedures performed in an ASC setting. The presence of major joint arthroplasty (27447), shoulder biceps fixation (23430), and high-volume carpal tunnel release (64721) suggests the facility is set up for operative orthopedics rather than only office-based care.
Revenue concentration on Medicare is meaningfully skewed toward a few high-revenue procedures: the provider’s top 3 Medicare codes account for 41.2% of its total Medicare revenue, with 27447, 23430 and 64721 explicitly driving that share. Those three codes include a knee arthroplasty and procedures addressing shoulder and median nerve pathology, so a small set of operative service lines is generating a large portion of Medicare receipts.
On the Medicaid side the provider shows extreme revenue concentration: the top 3 Medicaid codes account for 100.0% of the facility’s Medicaid revenue, led by 69436 (tympanostomy tubes) at $63.2K (61.1%) and 42820 (tonsil/adenoid removal in <12) at $39.3K (38.0%). This pattern indicates that Medicaid activity at this site is dominated by pediatric ENT procedures rather than the orthopedics-heavy Medicare mix.
Comparing scale across payers, Medicare revenue ($595.9K) substantially exceeds Medicaid revenue ($103.4K) in absolute terms, so Medicare is the dominant payer relationship on file. The provider is therefore not effectively single-payer but relies far more on Medicare reimbursement for overall revenue.
National and code-level competitive standing is mixed: 64721 (carpal tunnel release) ranks #91 of 3206 providers nationally (97th percentile; notably above typical national volume), indicating a strong national footprint for this specific hand surgery procedure. By contrast, 27447 (knee arthroplasty) ranks #9862 of 12089 (16th percentile; typical, unremarkable volume) and 23430 ranks #214 of 811 (70th percentile; typical, unremarkable volume), so the provider is a high-volume national participant for median-nerve surgery but a modest player for knee replacement at the national level.
State-level Medicaid competitiveness is concentrated and specific: 69436 ranks #4 of 23 in-state (86th percentile), showing above-typical in-state volume for tympanostomy tube placement, while 42820 ranks #16 of 21 (25th percentile), indicating more modest in-state activity for pediatric tonsil/adenoid procedures. Together these ranks imply the facility is a regional site for ENT pediatric procedures but not uniformly dominant across all Medicaid ENT codes.
The NPI enumeration date is 2005-09-13 (~21 years ago), signaling a long-tenured ASC with an established billing history. The longevity combined with the concentrated code mix (high Medicare orthopedic bills plus Medicaid pediatric ENT throughput) suggests established referral relationships and a stable operational footprint in Lewiston, ID.
Operational and quality-coding notes: the provider reports nonzero counts for quality/process codes (G8907: 507 claims, $1K revenue) and also submits many claims with zero paid for surgical antibiotic timing measures (G8918: 245 claims, $0 revenue; G8916: 30 claims, $0 revenue). These entries reflect documented measure reporting activity alongside clinical procedure billing and should be considered when evaluating operational and compliance reporting practices rather than as revenue drivers.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
20 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 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 | $6,610 | $105.7K |
| 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.… | 20 | $3,050 | $70.2K |
| 64721 | Neuroplasty or transposition of the median nerve at the carpal tunnel is done to treat a condition called carpal tunnel syndrome (CTS). The carpal tunnel is a narrow tunnel in the wrist through which… | 110 | $610 | $69.4K |
| 25609 | The provider surgically repairs a fracture of the lower radius, the larger of the two lower arm bones, beyond the joint or a separation of the radius from the joint through an incision and fixes… | 10 | $3,280 | $45.9K |
| 29880 | In this procedure, the provider performs arthroscopic examination of the knee joint. She removes the damaged and torn meniscus from the medial and lateral compartments of the knee joint along with… | 40 | $1,030 | $36.9K |
| 29881 | The provider examines the inside of the knee joint with an arthroscope. She repairs the joint by removing the meniscus, a crescent shaped cartilage cushion, from either the medial or lateral… | 30 | $1,010 | $30.1K |
| 29828 | The provider examines the tissue inside the shoulder joint with an arthroscope. She inserts additional instruments to repair an unstable biceps tendon, the fibrous band that connects the biceps… | 10 | $2,320 | $30.1K |
| 26055 | Trigger finger, or stenosing tenosynovitis, is when a finger remains in a bent position. It is painful to open or close the finger. A swollen tendon or formation of knots or nodules in the tendon may… | 60 | $460 | $27.2K |
| 26480 | In this procedure, the provider transfers or transplants a tendon in the carpometacarpal area or the back of the hand. The carpometacarpal area is the articulation of the wrist’s carpal bones with… | 30 | $1,020 | $26.4K |
| 63047 | The provider performs a laminectomy (excision of the thin bony plate at the back of a vertebra), facetectomy (excision of an area of a vertebra characterized by its smooth surface), and foraminotomy… | 10 | $2,310 | $25.4K |
Showing 1–10 of 20
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 20 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
20 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| 25609 | 1 | 10 | 10 | $3,280 | $45.9K |
| 29881 | 1 | 10 | 30 | $1,010 | $30.2K |
| 27447 | 82 | 110 | 30 | $640 | $25.1K |
| 64721 | 1 | 20 | 30 | $380 | $15.5K |
| 26055 | 6 | 20 | 50 | $250 | $12.2K |
| 29827 | 17 | 30 | 20 | $610 | $11.6K |
| 29828 | 6 | 10 | 10 | $750 | $10.6K |
| 25447 | 4 | 10 | 20 | $490 | $10.4K |
| 29880 | 1 | 10 | 10 | $600 | $10.2K |
| 23430 | 10 | 20 | 20 | $460 | $10.1K |
Showing 1–10 of 20
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 |
|---|---|---|---|---|
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 200 | $320 | $63.2K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 30 | $1,450 | $39.3K |
| 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… | 510 | $1 | $1K |
| G8916 | Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time | 30 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 250 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other Idaho providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Idaho median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 16 | 20 | 110 | $840 | $224.4K |
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 4 | 20 | 100 | $450 | $102.5K |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 7 | 10 | 260 | $1 | $740 |
| 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… | 7 | 20 | 210 | $1 | $680 |
| G8916 | Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time | 2 | 10 | 20 | $1 | $140 |
Other providers in the same ZIP code as Lewis & Clark Orthopaedic Institute 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.