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NPI 1972874907 · Raleigh, NC · Ambulatory Surgical Clinic/Center
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Capital City Surgery Center, LLC is a ambulatory surgical clinic/center provider located in Raleigh, North Carolina. This profile covers 29 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 | Capital City Surgery Center, LLC |
| Address | 23 Sunnybrook Rd |
| City | Raleigh |
| State | NC |
| ZIP | 27610 |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| NPI Enumerated | January 23, 2012 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicare | $3.1M |
| Medicaid | $62.4K |
Payer mix and scale are heavily Medicare‑weighted: the provider reported Total Medicare revenue of $3.1M versus Total Medicaid revenue of $62.4K, indicating Medicare is the dominant payer by a large margin. The precomputed concentration metrics show the top 3 Medicare codes account for 60.1% of Medicare revenue while the top 3 Medicaid codes account for 100.0% of Medicaid revenue, underscoring reliance on a few high‑revenue procedures across both payers.
Business and service‑line profile is consistent with a multi‑specialty ambulatory surgical center: the taxonomy is Ambulatory Surgical Clinic/Center and the code mix features high‑value ophthalmology (66984), complex spinal implant procedures (63685, 63655), and a broad set of orthopedic and hand/upper‑extremity procedures (e.g., 27447, 29827, 26055, 64721). This combination suggests same‑day surgical capability for cataract cases plus infrastructure to support implantable neurostimulator systems and routine musculoskeletal surgeries.
Medicare revenue concentration is focused on three high‑value lines: 66984 ($702.1K, 23.3% of Medicare revenue), 63685 ($697.3K, 23.2% of Medicare revenue), and 63655 ($410.6K, 13.6% of Medicare revenue), which together match the precomputed 60.1% share. That split indicates the center’s Medicare performance is driven roughly equally by cataract surgery and spinal neurostimulation/implant procedures, creating dependency on both ophthalmology throughput and implant workflows.
Medicaid activity is small and concentrated in a few pediatric/ENT and ENT‑related procedures: 69436 accounts for $37.3K (59.8% of Medicaid revenue), 42820 accounts for $20.2K (32.3%), and 66984 accounts for $4.9K (7.9%), which together equal the precomputed 100.0% of Medicaid revenue. This pattern suggests Medicaid volume is chiefly outpatient tympanostomy and pediatric tonsil/adenoid work rather than a broad Medicaid surgical portfolio.
Competitive standing is mixed across codes: for spine/stimulation procedures the provider ranks in the upper national percentiles (63655 ranks #20 of 245, 91th percentile; 63685 ranks #127 of 1281, 89th percentile), indicating above‑typical national presence in spinal neurostimulation. By contrast, cataract volume for 66984 (850 claims, $702.1K revenue) ranks #2155 of 15965 (86th percentile) and is characterized as typical, so the provider is not a dominant national cataract center but performs a meaningful number of cases.
There are clear statistical outliers in the procedural mix that signal specialty strengths: 26055 (149 claims, $69.6K revenue) is labeled an "extreme outlier, far above typical national volume" (99th percentile), and several codes are "notably above typical national volume," including 29827 (69 claims, $109.7K revenue, 98th percentile), 64721 (100 claims, $61K revenue, 95th percentile), 25447 (44 claims, $27.1K revenue, 95th percentile), and C9290 (36.2K claims, $36.2K revenue, 94th percentile). These high‑percentile signals point to concentrated expertise in specific hand/shoulder procedures and use of specific injectable products.
Operational tenure is long enough to be established: the NPI was enumerated on 2012-01-23 (~14 years ago), implying stable registration and likely sustained service lines over multiple reimbursement cycles. Given the combination of long tenure, concentrated high‑value Medicare procedures, and the presence of notable outlier volumes in several codes, the facility should be considered an established ambulatory surgical center with specialized program lines in spine stimulation, hand/shoulder surgery, and outpatient ophthalmology.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
29 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… | 850 | $830 | $702.1K |
| 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… | 40 | $18,850 | $697.3K |
| 63655 | In this procedure, the provider removes a portion of the vertebra called the lamina and places a permanent plate/paddle electrode in the epidural space, or area between the dura membrane and the wall… | 30 | $13,690 | $410.6K |
| 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… | 40 | $7,010 | $259.4K |
| 27130 | In this procedure, the provider surgically replaces the hip joint by prosthesis, or artificial hip joint. He replaces both the femoral and acetabular components with or without using an autograft or… | 20 | $7,240 | $123.1K |
| 29827 | The provider examines the tissue inside the shoulder joint with an arthroscope. She inserts additional instruments to repair a torn rotator cuff, the grouping of muscles and tendons that surround and… | 70 | $1,590 | $109.7K |
| 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… | 40 | $2,340 | $89.1K |
| 27446 | In this procedure, the provider reconstructs the diseased or damaged medial or lateral compartment of the knee along with the femoral condyles and tibial plateaus to relieve pain and improve the… | 10 | $7,010 | $84.2K |
| 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… | 150 | $470 | $69.6K |
| 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… | 100 | $610 | $61K |
Showing 1–10 of 29
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 29 CPT/HCPCS codes.
View: State1 / 2
Full comparison — all codes billed, vs. state median
29 rows
| CPT/HCPCS Code | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|
| J1097 | 13 | 10 | 1,240 | $80 | $151.9K |
| 63685 | 10 | 40 | 20 | $5,660 | $147.2K |
| 63655 | 3 | 20 | 20 | $3,670 | $77.1K |
| 66984 | 189 | 580 | 230 | $70 | $73.7K |
| 27447 | 188 | 460 | 30 | $1,000 | $41.8K |
| 27446 | 13 | 20 | 10 | $2,290 | $36.6K |
| 27130 | 234 | 320 | 30 | $990 | $30.8K |
| 29827 | 7 | 120 | 20 | $1,000 | $25K |
| 29828 | 6 | 50 | 20 | $980 | $24.6K |
| 29880 | 7 | 20 | 20 | $810 | $17K |
Showing 1–10 of 29
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. | 160 | $230 | $37.3K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 40 | $470 | $20.2K |
| 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… | 110 | $50 | $4.9K |
| 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… | 90 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 10 | $0 | $0 |
How this provider's Medicaid billing volume and revenue compare to other North Carolina providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. North Carolina median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 69436 | This procedure is a tympanostomy requiring the insertion of a ventilation tube under general anesthesia. | 38 | 90 | 120 | $350 | $184.9K |
| 42820 | The provider removes the tonsils and adenoids in a patient younger than 12 years old. | 36 | 60 | 100 | $390 | $123.1K |
| 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… | 41 | 70 | 130 | $160 | $107.5K |
| 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… | 34 | 60 | 170 | $0 | $0 |
| G8918 | Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis | 40 | 40 | 70 | $0 | $0 |
Other providers in the same ZIP code as Capital City Surgery Center, LLC, ranked by combined Medicare and Medicaid revenue.
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