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

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

Capstone Behavioral Healthcare, Inc (NPI 1174598908)

Capstone Behavioral Healthcare, Inc is a community/behavioral health agency provider located in Newton, Iowa. This profile covers 0 Medicare and 27 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	Capstone Behavioral Healthcare, Inc
Address	1123 1st Ave E
City	Newton
State	IA
ZIP	50208
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	February 23, 2006

Payer Source	Total Paid
Medicaid	$17M
Medicare	$0

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

27 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2016	Comprehensive community support services, per diem	41,580	$140	$5.7M
99490	The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the…	16,750	$190	$3.2M
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…	23,860	$100	$2.3M
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	7,760	$130	$1M
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…	16,090	$60	$933.2K
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…	9,530	$100	$914.6K
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…	10,570	$80	$856.4K
96127	The provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument (such as a recognized form). The provider scores and documents the assessment.	6,700	$90	$582.8K
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…	2,450	$210	$513.7K
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…	5,500	$50	$252.8K

Showing 1–10 of 27

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Iowa Distribution

Capstone Behavioral Healthcare, Inc — 3 of 19 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Iowa

Full comparison — all codes billed, vs. Iowa median

27 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2016	Comprehensive community support services, per diem	43	180	10,790	$390	$15.2M
99490	The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the…	28	60	16,120	$150	$3.8M
H0037	Community psychiatric supportive treatment program, per diem	23	30	1,050	$210	$800.8K
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…	75	680	670	$70	$343.5K
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…	84	1,060	480	$40	$154.5K
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…	111	1,310	760	$20	$153.1K
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…	21	140	210	$120	$152.1K
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…	5	610	550	$70	$145.9K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	10	400	110	$100	$101.1K
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…	28	280	530	$40	$80.1K

Showing 1–10 of 27

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Progress Industries	IA	Day Training/Habilitation Specialist	$0	$53M
Mercy Medical Center-newton	IA	General Acute Care Hospital	$0	$3.6M
Newton Clinic PC	IA	Family Medicine Physician	$0	$3.3M
Newton C.s.d.	IA	Local Education Agency (LEA)	$0	$3.3M
City Of Newton	IA	Land Ambulance	$266.1K	$2.3M
Integrated Treatment Services LLC	IA	Community/Behavioral Health Agency	$0	$1.4M
Des Moines River Physicians, LLC	IA	Emergency Medicine Physician	$0	$1.3M
Hy-vee Inc	IA	Community/Retail Pharmacy	$191.8K	$118.9K
Orville Bunker	IA	Family Medicine Physician	$203.5K	$0
Tze Chan	IA	Internal Medicine Physician	$193.7K	$0

Capstone Behavioral Healthcare, Inc — Billing Profile & Reimbursement Data

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Capstone Behavioral Healthcare, 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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