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

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

Rock Valley Community Programs, Inc. (NPI 1134306293)

Rock Valley Community Programs, Inc. is a mental health clinic/center (including community mental health center) provider located in Janesville, Wisconsin. This profile covers 0 Medicare and 10 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Rock Valley Community Programs, Inc.
Address	1820 Center Ave Ste 170
City	Janesville
State	WI
ZIP	53546
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	January 30, 2008

Payer Source	Total Paid
Medicaid	$1.2M
Medicare	$0

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

10 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…	10,160	$70	$711.2K
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	60	$6,270	$376.3K
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	430	$90	$39.8K
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…	990	$40	$34.8K
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…	1,100	$20	$19.8K
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…	640	$30	$19.7K
90833	In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the…	430	$40	$17.4K
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…	770	$20	$16.9K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	20	$90	$1.7K
80305	The lab analyst performs presumptive drug test(s) by any method that the analyst can read by direct optical observation only, without instrument assistance, to screen for any number of drug classes…	50	$1	$190

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wisconsin Distribution

Rock Valley Community Programs, Inc. — 1 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

10 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	39	40	1,130	$660	$2.3M
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…	534	1,630	270	$40	$205.3K
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…	632	1,760	250	$40	$173.2K
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…	31	900	410	$70	$130.4K
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…	33	110	270	$50	$87.4K
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	44	170	110	$80	$62.4K
90833	In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the…	63	140	340	$30	$49.2K
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…	78	260	200	$30	$27.9K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	286	370	60	$60	$21.5K
80305	The lab analyst performs presumptive drug test(s) by any method that the analyst can read by direct optical observation only, without instrument assistance, to screen for any number of drug classes…	103	130	470	$10	$13.6K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
County Of Rock	WI	Community/Behavioral Health Agency	$0	$26.5M
County Of Rock	WI	Community/Behavioral Health Agency	$0	$23.1M
Ssm Health Care Of Wisconsin, Inc.	WI	General Acute Care Hospital	$0	$8.4M
County Of Rock	WI	Community/Behavioral Health Agency	$0	$6.6M
County Of Rock	WI	Community/Behavioral Health Agency	$0	$5.7M
Maher Mourad	WI	Hospitalist Physician	$348.8K	$82.4K
Walgreen Co	WI	Pharmacy	$201.4K	$27.5K
Herbert Webb	WI	Optometrist	$30.4K	$132.2K
Monica Simionescu	WI	Neurology Physician	$106.8K	$46.9K
David Nelsen	WI	Dermatology Physician	$146.1K	$5.9K

Rock Valley Community Programs, Inc. — Billing Profile & Reimbursement Data

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Rock Valley Community Programs, Inc. — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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