Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or South Dakota for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to South Dakota only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. South Dakota (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Southern Plains Behavioral Health Services Inc (NPI 1043350440)

Field	Value
Entity Type	Organization
Organization	Southern Plains Behavioral Health Services Inc
Address	500 E 9th Street
City	Winner
State	SD
ZIP	57580
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	February 7, 2007

Payer Source	Total Paid
Medicaid	$6.8M
Medicare	$0

Key Findings

This provider is effectively a Medicaid-focused operation: there is no Medicare billing on file and lifetime Medicaid revenue is $6.8M, so Medicaid is the sole material payer reflected in the data. The absence of Medicare billing suggests the organization’s patient mix and contracts are concentrated in state Medicaid programs rather than Medicare populations.

Revenue is highly concentrated in three codes that together account for 99.7% of the provider’s Medicaid revenue: H2021 (64.2%, $4.3M), H2016 (25.2%, $1.7M), and 90863 (10.3%, $694.3K). This tight code concentration means most of the provider’s financial performance depends on continuing reimbursement and volume for time-based community supports and medication-management services.

The code mix points to a community behavioral health operations model centered on intensive, recurring support: H2021 is a high-volume, per-15-minute community-based wrap-around service and H2016 is a per diem comprehensive community support service, while 90863 reflects pharmacological management tied to psychotherapy encounters. Together these suggest the organization delivers longitudinal care and care coordination rather than episodic specialty or inpatient services.

Operational volume indicators reinforce the service-line characterization: H2021 appears in 47.6K claims and H2016 in 18.5K claims, signaling a high-frequency, time-based service delivery model that likely relies on multi-disciplinary staff delivering many short-interval contacts. The 5.6K claims for 90863 indicate a consistent role for medication review within psychotherapy encounters rather than standalone psychiatric billing.

State-level competitive standing is modest across its main codes: H2021 ranks #6 of 11 providers in-state (50th percentile) and is described as typical, H2016 ranks #8 of 11 (30th percentile) and is unremarkable for volume, and 90863 ranks #7 of 12 (45th percentile) and is likewise typical. Those rankings imply SOUTHERN PLAINS BEHAVIORAL HEALTH SERVICES INC is a routine, mid-tier provider of these community behavioral services in South Dakota rather than a dominant market leader.

Telehealth and intake/assessment activity are present but small relative to total revenue: Q3014 shows 380 claims for $7.2K (0.1% of Medicaid revenue) and ranks #9 of 33 in-state (75th percentile), indicating the organization functions as an originating telehealth site more often than many peers despite low absolute revenue. By contrast, initial psychiatric evaluations (90791) are minimal at 21 claims and $3.7K (0.1% of revenue), ranking #52 of 68 (24th percentile), which suggests few standalone new-patient psychiatric assessments.

Average paid-per-claim patterns show modest per-encounter reimbursement: H2021 averages $91 paid/claim, H2016 averages $92 paid/claim, and 90863 averages $123 paid/claim. The relatively higher average for 90863 is consistent with medication-management encounters receiving higher payment per claim than time-based wrap-around or per-diem community supports.

The provider’s NPI was enumerated on 2007-02-07 (~19 years ago), indicating a long-standing presence in the market. That tenure combined with concentrated Medicaid revenue suggests operational stability within state-funded community behavioral services but also creates revenue concentration risk if state policy or reimbursement for these specific codes changes.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

6 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2021	Community-based wrap-around services, per 15 minutes	47,600	$90	$4.3M
H2016	Comprehensive community support services, per diem	18,530	$90	$1.7M
90863	The provider prescribes and reviews medications for pharmacological management after psychotherapy services at the same encounter.	5,650	$120	$694.3K
99412	The provider offers advice on maintaining and improving health to a group of patients for roughly an hour.	140	$70	$9.7K
Q3014	Telehealth originating site facility fee	380	$20	$7.2K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	20	$170	$3.7K

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other South Dakota providers billing the same CPT/HCPCS codes.

Claims Volume vs. South Dakota Distribution

Southern Plains Behavioral Health Services Inc — 0 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

6 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2016	Comprehensive community support services, per diem	8	10	29,180	$80	$3.6M
H2021	Community-based wrap-around services, per 15 minutes	6	10	47,600	$90	$3.5M
90863	The provider prescribes and reviews medications for pharmacological management after psychotherapy services at the same encounter.	7	10	5,650	$90	$550.2K
99412	The provider offers advice on maintaining and improving health to a group of patients for roughly an hour.	3	10	140	$50	$97.5K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	52	70	60	$100	$51.4K
Q3014	Telehealth originating site facility fee	9	30	190	$20	$9.7K

Nearby Providers

Other providers in the same ZIP code as Southern Plains Behavioral Health Services Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Community Connections Inc	SD	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$22.6M
Winner Regional Healthcare Center	SD	Rural Health Clinic/Center	$0	$3M
Twobros. Inc.	SD	Assisted Living Facility	$0	$1.3M
Guardian Flight LLC	SD	Air Ambulance	$336.6K	$405K
Dr Daniel L Peters Od PC	SD	Optometrist	$0	$396.6K
Winner Regional Healthcare Center	SD	Critical Access Hospital	$0	$390.1K
Manke Family Dentistry, PC	SD	Dentist	$0	$224.9K
County Of Tripp	SD	Land Ambulance	$154.3K	$65.3K
Winner Regional Health Clinic	SD	Family Nurse Practitioner	$0	$192.7K
Winner Physical Therapy Inc	SD	Physical Therapy Clinic/Center	$0	$162K

Southern Plains Behavioral Health Services Inc — Billing Profile & Reimbursement Data

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Southern Plains Behavioral Health Services Inc — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References