Loading...
NPI 1063921047 · Seaford, DE · Substance Abuse Rehabilitation Facility
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Addiction Medical Facility, LLC is a substance abuse rehabilitation facility provider located in Seaford, Delaware. This profile covers 3 Medicare and 31 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 | Addiction Medical Facility, LLC |
| Address | 400 Health Services Dr Ste 401 |
| City | Seaford |
| State | DE |
| ZIP | 19973 |
| Taxonomy | Substance Abuse Rehabilitation Facility |
| NPI Enumerated | September 22, 2017 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $9M |
| Medicare | $98.8K |
This provider is overwhelmingly Medicaid-driven: lifetime Medicaid revenue is $9M versus total Medicare revenue of $98.8K, so Medicaid clearly dominates the payer mix and operational footprint. Analysts should treat Medicaid contracting and utilization as the primary driver of this entity's financial and clinical activity rather than Medicare programs.
The code mix and descriptions indicate the organization operates primarily as a medication-assisted opioid treatment and behavioral health service provider. On the Medicare side the top codes are G2067, G2080, and G2074 (the precomputed top-3 codes account for 100.0% of Medicare revenue), and on Medicaid the leading codes include H0020, 99211, and psychotherapy codes such as 90837 — a mix consistent with methadone administration, frequent low-intensity visits, and counseling/therapy.
Medicare activity is tightly concentrated: the provider's three Medicare codes account for 100.0% of its Medicare revenue, with G2067 alone representing 75.4% of Medicare receipts, G2080 20.8%, and G2074 3.8%. Operationally this signals the provider bills Medicare mainly as a medicare-enrolled opioid treatment program offering weekly bundles and add-on counseling time rather than broad ambulatory care.
Competitive standing on Medicare is mixed by code. G2080 shows unusually high national volume for this provider (rank #2 of 18, 94th percentile; described as notably above typical national volume), while G2067 is modest nationally (rank #739 of 830, 11th percentile; described as typical/unremarkable), indicating targeted strength in counseling add-on units but otherwise limited Medicare reach.
Medicaid revenue is highly concentrated in three codes that together account for 89.9% of Medicaid revenue: 99211 (43.9%), H0020 (41.9%), and 90837 (4.1%). 99211 is an extreme outlier in-state (rank #1 of 72, 100th percentile; described as far above typical state volume), which points to extraordinarily high volume of low-level outpatient encounters driving a large share of Medicaid receipts.
Several Medicaid codes mark notable in-state concentration of specific services beyond core dispensing. H0020 (methadone administration) is large in absolute claims (234.9K claims) and ranks #4 of 13 in-state (75th percentile), while 80305 (presumptive drug testing) ranks #2 of 22 (95th percentile) and 99408 (screening/intervention) ranks #1 of 10 (100th percentile); these positions suggest very high utilization of drug testing and brief intervention services relative to most peers.
The provider’s operational model appears to be high-frequency, low-intensity encounters: 99211 shows 178.9K claims at $22 avg paid/claim and H0020 shows 234.9K claims at $16 avg paid/claim, indicating routine, repeated dispensing/visit encounters common to opioid treatment programs. This pattern has implications for capacity, billing oversight, and per-encounter reimbursement strategies when negotiating with Medicaid.
For contracting and utilization management, analysts should note the provider’s narrow revenue base and specialized service mix: Medicaid accounts for nearly all scale and the top Medicaid codes are extreme or notable outliers in-state. Given the NPI was enumerated 2017-09-22 (~9 years ago) and the taxonomy is Substance Abuse Rehabilitation Facility, payers should prioritize review of Medicaid agreements, capacity planning, and service-level performance for methadone administration, high-volume 99211 visits, and associated drug testing and counseling services.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
3 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| G2067 | Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed… | 310 | $240 | $74.4K |
| G2080 | Each additional 30 minutes of counseling in a week of medication assisted treatment, (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code… | 640 | $30 | $20.5K |
| G2074 | Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services… | 20 | $200 | $3.7K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 3 CPT/HCPCS codes.
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.
31 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99211 | An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional. | 178,900 | $20 | $3.9M |
| H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | 234,950 | $20 | $3.8M |
| 90837 | In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or… | 4,100 | $90 | $365.1K |
| 90832 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 3,590 | $50 | $168.9K |
| 90834 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 2,460 | $70 | $164.6K |
| H0001 | Alcohol and/or drug assessment | 1,040 | $80 | $86.6K |
| 90791 | In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. | 610 | $110 | $65K |
| 99212 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,… | 1,680 | $40 | $62.2K |
| J0571 | Buprenorphine, oral, 1 mg | 18,610 | $1 | $55.8K |
| 99408 | The provider spends 15 to 30 minutes screening a patient for abuse of alcohol or another non–tobacco substance. The provider then performs a brief intervention at the same session. | 1,850 | $30 | $51.9K |
Showing 1–10 of 31
How this provider's Medicaid billing volume and revenue compare to other Delaware providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Delaware median
31 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | 4 | 10 | 77,020 | $10 | $3.4M |
| 99284 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making. | 32 | 40 | 770 | $110 | $1.9M |
| 99285 | The provider sees a patient for an emergency department visit involving evaluation and management (E/M). The visit involves a high level of medical decision making. | 26 | 30 | 1,350 | $110 | $1.5M |
| H0015 | Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including… | 15 | 20 | 1,500 | $90 | $361K |
| T1015 | Clinic visit/encounter, all-inclusive | 43 | 50 | 1,490 | $80 | $340.7K |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 11 | 10 | 860 | $40 | $316.4K |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 284 | 500 | 1,130 | $50 | $235.1K |
| 90837 | In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or… | 44 | 240 | 700 | $60 | $205.6K |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 296 | 540 | 1,100 | $40 | $185.3K |
| 90834 | In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere… | 24 | 80 | 790 | $40 | $180.4K |
Showing 1–10 of 31
Other providers in the same ZIP code as Addiction Medical Facility, 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.