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

Why is the Medicaid comparison limited to Montana 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. Montana (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.

Sunburst Health LLC (NPI 1093297764)

Field	Value
Entity Type	Organization
Organization	Sunburst Health LLC
Address	2620 Connery Way
City	Missoula
State	MT
ZIP	59808
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	August 30, 2018

Payer Source	Total Paid
Medicaid	$6.1M
Medicare	$0

Key Findings

SUNBURST HEALTH LLC is effectively a Medicaid-focused provider: the profile shows no Medicare billing on file and $6.1M in lifetime Medicaid revenue, indicating the organization’s revenue base is concentrated in state Medicaid programs rather than Medicare. This payer mix suggests operations and growth are tightly linked to Medicaid policy, reimbursement levels, and managed-care arrangements in Montana.

Revenue concentration is high: the precomputed top 3 Medicaid codes (90837, T1016, 90791) account for 58.1% of this provider’s total Medicaid revenue. That concentration signals reliance on a small set of services—chiefly long-session psychotherapy, case management, and psychiatric evaluations—for the majority of Medicaid dollars.

The top revenue driver is 90837 (31.8% of the provider’s Medicaid revenue; $1.9M revenue, 27K claims, $72 avg paid/claim), and the provider ranks #6 of 1203 in-state for this code. This code is labeled an extreme outlier, far above typical state volume, which indicates SUNBURST delivers unusually large volumes of long-session psychotherapy relative to most Montana peers and is a statewide leader for that service.

T1016 (case management) contributes $1.1M (17.6% of Medicaid revenue; 24.5K claims, $44 avg paid/claim) and ranks #11 of 53 providers in-state (81th percentile). The profile here is of a high-volume case management operation that appears typical in scale among the more active case-management providers in the state rather than uniquely dominant.

90791 (psychiatric evaluation) is another principal revenue source at $529.1K (8.7% of Medicaid revenue; 6.2K claims, $85 avg paid/claim) and ranks #3 of 190 providers in-state (99th percentile). This code is also described as an extreme outlier, suggesting SUNBURST performs substantially more initial psychiatric evaluations than nearly all in-state peers and positions the clinic as a major access point for diagnostic workups.

The code mix beyond the top three shows a broad behavioral health service line: high-volume psychotherapy across durations (90834, 90832), large group-therapy activity (90853 with 13.6K claims and $190.3K revenue, ranked #7/106 at the 94th percentile), and medically oriented E/M visits (99214, 99213, 99205). The presence of both intensive outpatient substance-use code H0015 ($394K, 6.4% of Medicaid revenue) and residential H0019 ($312.2K, 5.1% of Medicaid revenue, one of only two in-state billers) indicates SUNBURST operates multiple levels of behavioral-health care including outpatient therapy, case management, IOP, and some residential services.

Competitive standing is mixed by service line: SUNBURST is a dominant statewide outlier for long-session psychotherapy and psychiatric evaluations (90837 and 90791), notably above typical volumes for those codes, while its case management (T1016) and many E/M codes are typical or moderately above peers (for example, 99205 ranks #6 of 67, described as notably above typical state volume). This pattern implies the organization is a market leader for intensive therapy and access evaluations but a more conventional participant for routine case management and some outpatient E/M services.

Operational and data notes: the NPI was enumerated on 2018-08-30 (~8 years ago), establishing a multi-year presence in the state. The claims list also includes several codes with $0 avg paid/claim and $0 revenue on file (for example, 99423, 99408, G2063, H0036), which appear in the dataset as billed but show no paid dollars; these items merit review during contract or audit work to understand whether they reflect non-covered services, reporting conventions, or other data artifacts.

Medicaid: Complete Services Breakdown

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

24 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	27,030	$70	$1.9M
T1016	Case management, each 15 minutes	24,490	$40	$1.1M
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	6,230	$90	$529.1K
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…	5,780	$90	$502.8K
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…	1,340	$290	$394K
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	200	$1,590	$312.2K
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…	6,320	$50	$284.4K
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…	5,440	$40	$190.3K
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	13,590	$10	$190.3K
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…	2,140	$70	$145.7K

Showing 1–10 of 24

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

Sunburst Health LLC — 2 of 20 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

24 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0036	Community psychiatric supportive treatment, face-to-face, per 15 minutes	89	90	5,740	$80	$1.6M
T1016	Case management, each 15 minutes	11	50	2,720	$50	$1.4M
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…	12	20	1,510	$170	$848K
H2019	Therapeutic behavioral services, per 15 minutes	18	40	3,280	$50	$759.9K
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…	65	530	580	$70	$224.6K
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…	170	520	730	$40	$196.4K
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	2	10	210	$880	$185.7K
H0038	Self‑help/peer services, per 15 minutes	17	40	1,050	$50	$171.5K
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…	6	1,200	750	$80	$143.2K
H2014	Skills training and development, per 15 minutes	5	10	1,050	$70	$115K

Showing 1–10 of 24

Related Providers

Other providers that share a Tax Identification Number (TIN) with Sunburst Health LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ann Finnegan	MT	Clinical Social Worker	$19.7K	$0
Heidi Whyte	MT	Clinical Social Worker	$5K	$0

Nearby Providers

Other providers in the same ZIP code as Sunburst Health LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Consumer Direct Care Network Virginia	MT	Home Health Agency	$0	$2.1B
Consumer Direct Personal Care, LLC	MT	In Home Supportive Care Agency	$0	$49.1M
Hkj Inc	MT	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$15.2M
We Care Behavioral Health LLC	MT	Clinic/Center	$0	$14.8M
Partners In Home Care, Inc	MT	Nursing Care Agency	$0	$13M
Hkj Inc	MT	Case Management Agency	$0	$11.6M
Providence Health & Services Mt	MT	Family Medicine Physician	$0	$4.9M
Welltower Tenant Group LLC	MT	Assisted Living Facility	$0	$3.8M
Norco, Inc	MT	Durable Medical Equipment & Medical Supplies	$0	$3.8M
County Of Missoula School Dist 4	MT	Local Education Agency (LEA)	$0	$3.4M

Sunburst Health LLC — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References