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 West Virginia for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Prestera Center For Mental Health Services, Inc (NPI 1043436918)

Field	Value
Entity Type	Organization
Organization	Prestera Center For Mental Health Services, Inc
Address	3375 Us Route 60
City	Huntington
State	WV
ZIP	25705
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	April 18, 2007

Payer Source	Total Paid
Medicaid	$18.7M
Medicare	$0

Key Findings

PRESTERA CENTER FOR MENTAL HEALTH SERVICES, INC reports no Medicare billing on file and $18.7M in lifetime Medicaid revenue, making it effectively a single-payer (Medicaid) operation based on available claims data. Analysts should treat Medicaid reimbursement trends as the primary driver of the organization’s financial profile because there is no Medicare activity to offset Medicaid exposure.

Revenue is highly concentrated: the top three Medicaid codes account for 100.0% of the provider’s Medicaid revenue, with a single code, T1019, representing 98.0% of Medicaid receipts. This concentration indicates that the provider’s business is overwhelmingly supported by one service line rather than a diversified mix of Medicaid procedures.

The dominant codes reflect the provider’s service model. T1019 (Personal care services, per 15 minutes) plus nursing-related codes T1002 (RN services, up to 15 minutes) and T1001 (Nursing assessment/evaluation) indicate the organization operates primarily as a community-based personal care and nursing services provider delivering care under individualized plans of treatment rather than inpatient or facility-based services.

Operational scale is driven almost entirely by T1019: 14.1K claims, $1303 avg paid/claim, and $18.4M revenue, which constitutes 98.0% of the provider’s Medicaid revenue. The per-claim average for T1019 ($1303) combined with the high claim volume shows the provider bills high-value, time-based personal care units at scale under Medicaid.

Competitive standing on core codes is mixed: for T1019 the provider ranks #15 of 78 in-state and sits in the 82th percentile, described as a typical, unremarkable volume for this code, signalling it is a meaningful but not dominant provider for this service in-state. For the secondary codes, T1002 ranks #11 of 151 (93th percentile) and T1001 ranks #12 of 60 (81th percentile), both labeled typical, unremarkable volume for these codes; these rankings show relative strength in RN and nursing assessment services by rank but those services contribute a small share of revenue.

Although T1002 and T1001 are modest revenue contributors (T1002: 15.2K claims, $17 avg paid/claim, $258.9K revenue = 1.4% of Medicaid revenue; T1001: 912 claims, $119 avg paid/claim, $108.5K revenue = 0.6% of Medicaid revenue), their higher percentile ranks indicate the provider is comparatively active in nursing service delivery relative to many peers even if those codes do not materially drive overall revenue.

The provider has a long-tenured NPI (enumerated 2007-04-18 (~19 years ago)), suggesting stable participation in Medicaid networks and established operational processes for delivering community behavioral health and personal care services. That tenure supports the interpretation that the current concentrated service mix is an intentional, sustained operating model rather than a transient pattern.

Concentration risk and strategic implications are material: with 98.0% of Medicaid revenue tied to T1019 and no Medicare revenue, any policy change, rate adjustment, or utilization shift affecting T1019 could materially impact the organization’s topline. Conversely, this specialization also implies potential operational expertise and efficiency in delivering personal care services that payers or managed care plans might value when contracting for community-based care.

Medicaid: Complete Services Breakdown

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

3 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	14,100	$1,300	$18.4M
T1002	Rn services, up to 15 minutes	15,230	$20	$258.9K
T1001	Nursing assessment / evaluation	910	$120	$108.5K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Prestera Center For Mental Health Services, Inc — 0 of 3 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

3 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	15	80	4,510	$270	$4.7M
T1002	Rn services, up to 15 minutes	11	150	1,980	$40	$232.6K
T1001	Nursing assessment / evaluation	12	60	200	$110	$90.3K

Nearby Providers

Other providers in the same ZIP code as Prestera Center For Mental Health Services, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ncgcare Acquisition, LLC	WV	Psychiatry Physician	$0	$40.3M
Radiology Inc	WV	Diagnostic Radiology Physician	$0	$15.2M
Valley Health Systems Inc	WV	Federally Qualified Health Center (FQHC)	$0	$13.2M
Prestera Center For Mental Health Services, Inc	WV	Developmental Disabilities Clinic/Center	$0	$13M
St. Mary's Himg, LLC	WV	Internal Medicine Physician	$0	$2.6M
Associates In Psychology And Therapy, Inc.	WV	Psychologist	$0	$1.5M
Valley Health Systems, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$1.4M
Ultimate Health Services Inc	WV	Family Medicine Physician	$0	$908.1K
Vishal Verma	WV	Ophthalmology Physician	$419.8K	$0
Ahmed Abdelgaber	WV	Family Medicine Physician	$377.5K	$0

Prestera Center For Mental Health Services, Inc — Billing Profile & Reimbursement Data

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Prestera Center For Mental 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