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

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

State Of Missouri (NPI 1184259913)

Field	Value
Entity Type	Organization
Organization	State Of Missouri
Address	1706 E Elm St
City	Jefferson City
State	MO
ZIP	65101
Taxonomy	Addiction (Substance Use Disorder) Counselor
NPI Enumerated	March 12, 2020

Payer Source	Total Paid
Medicaid	$271.2M
Medicare	$0

Key Findings

This entity is effectively a Medicaid-focused provider: there is no Medicare billing on file and the provider reports $271.2M in total Medicaid revenue, indicating a single-payer (Medicaid) scale of operations for all billings shown. Analysts should treat Medicare comparisons as not applicable for this NPI because no Medicare activity is reported.

Revenue is highly concentrated in a small set of behavioral health and SUD codes: the top three Medicaid codes (H2036, H2015, H0004) together account for 50.2% of the provider’s total Medicaid revenue. Those codes individually generate $59.8M (H2036, 22.1%), $45.1M (H2015, 16.7%), and $30.8M (H0004, 11.4%), identifying a narrow set of services driving most revenue.

The code mix indicates a broad substance use disorder treatment continuum and community behavioral health orientation: high-revenue per-diem residential care (H2036, 173.8K claims, $59.8M), intensive community-based support delivered by time units (H2015, 474.7K claims, $45.1M), and frequent behavioral health counseling (H0004, 446.4K claims, $30.8M) point to combined residential, intensive outpatient, and community support programs. Additional codes with large volumes—H0020 methadone services (615.7K claims, $24M), H0005 group counseling (513.5K claims, $19M), and H0015 intensive outpatient (90.1K claims, $18M)—confirm a full-spectrum SUD treatment operation rather than a single-service clinic.

Statewide competitive standing is dominant across core SUD/behavioral-health lines: the provider ranks #1 in-state at the 100th percentile for many principal codes (H2036 #1 of 9; H2015 #1 of 18; H0004 #1 of 40; H0020 #1 of 11; H0005 #1 of 23), making it a leading Medicaid provider for these services in Missouri. Where ranks differ, the provider still sits at high percentiles (for example, H0038 is #2 of 36 at the 97th percentile and 99214 is #26 of 3166 at the 99th percentile), indicating strong statewide reach beyond SUD-only billing.

Several lines are flagged as statistical outliers relative to in-state peers: multiple high-volume codes are labeled as "extreme outlier" or "far above typical state volume" (notably H2015, H0004, H0020, H0005, H0015), while others are described as "notably above typical" (H2036, H0001). This pattern signals volumes well beyond typical providers in Missouri for the same service categories, which should inform network-construction and utilization-management reviews.

Operational scale is evident in sheer claim counts across many codes, consistent with a large, programmatic provider: examples include 615.7K claims for H0020, 474.7K claims for H2015, 513.5K claims for H0005, and 446.4K claims for H0004. These sustained volumes suggest high throughput and capacity to deliver frequent, repeat-treatment services typical of statewide SUD programs or centralized public behavioral-health operations.

The provider’s billing profile shows clinical breadth beyond SUD-specific codes, indicating integrated care capabilities: significant E/M activity (99214 with 42.9K claims and $3.6M, 99213 with 22.6K claims and $1.4M, and higher-level new-patient codes 99205/99204) plus psychiatric evaluation 90791 (3.6K claims, $353.5K) and nursing services T1002/T1003 (167.6K and 54.4K claims respectively) point to embedded medical and nursing services supporting behavioral-health treatment. This mix is relevant for payers evaluating bundled service offerings or care coordination pathways.

The NPI was enumerated on 2020-03-12 (~6 years ago), establishing a relatively recent enrollment date; combined with the high lifetime Medicaid revenue and large claim volumes, this suggests the provider has scaled rapidly under its current enrollment and become a major Medicaid SUD/behavioral-health supplier in Missouri within a short period. Tenure should be considered alongside state-dominant ranking when assessing contracting, capacity planning, and quality oversight needs.

Medicaid: Complete Services Breakdown

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

32 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2036	Alcohol and/or other drug treatment program, per diem	173,800	$340	$59.8M
H2015	Comprehensive community support services, per 15 minutes	474,710	$100	$45.1M
H0004	Behavioral health counseling and therapy, per 15 minutes	446,400	$70	$30.8M
H0020	Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)	615,700	$40	$24M
H0005	Alcohol and/or drug services; group counseling by a clinician	513,530	$40	$19M
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…	90,080	$200	$18M
H2012	Behavioral health day treatment, per hour	299,170	$50	$14.1M
H0011	Alcohol and/or drug services; acute detoxification (hospital inpatient) per diem	24,320	$460	$11.2M
H0001	Alcohol and/or drug assessment	33,240	$300	$9.9M
T1002	Rn services, up to 15 minutes	167,640	$50	$7.5M

Showing 1–10 of 32

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Missouri Distribution

State Of Missouri — 23 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Missouri

Full comparison — all codes billed, vs. Missouri median

32 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2036	Alcohol and/or other drug treatment program, per diem	1	10	17,770	$200	$7.4M
H0011	Alcohol and/or drug services; acute detoxification (hospital inpatient) per diem	1	10	15,660	$360	$5.6M
T2048	Behavioral health; long-term care residential (non-acute care in a residential treatment program where stay is typically longer than 30 days), with room and board, per diem	1	10	460	$150	$3.7M
H2015	Comprehensive community support services, per 15 minutes	1	20	4,550	$50	$2.5M
H0020	Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)	1	10	4,120	$40	$2.3M
H2012	Behavioral health day treatment, per hour	1	10	33,050	$30	$1.9M
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	10	1,150	$160	$1.4M
H0001	Alcohol and/or drug assessment	1	10	380	$280	$1.1M
H0004	Behavioral health counseling and therapy, per 15 minutes	1	40	3,680	$30	$978K
H0005	Alcohol and/or drug services; group counseling by a clinician	1	20	16,420	$20	$858.5K

Showing 1–10 of 32

Nearby Providers

Other providers in the same ZIP code as State Of Missouri, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
State Of Missouri	MO	Rehabilitation Psychologist	$0	$493.6M
State Of Missouri	MO	Rehabilitation Psychologist	$0	$91.5M
State Of Missouri	MO	Local Education Agency (LEA)	$0	$39M
Cole County Residential Services, Inc	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$13.2M
Curators Of The University Of Missouri	MO	General Acute Care Hospital	$0	$12.1M
Central Connections, Inc	MO	Case Management Agency	$0	$8.6M
State Of Missouri	MO	Clinical Medical Laboratory	$0	$7.8M
Capital Region Medical Center	MO	Family Medicine Physician	$0	$4.4M
Community Health Ctr Of Central Missouri	MO	Federally Qualified Health Center (FQHC)	$0	$4.4M
Paige Hedgpath Od,pc	MO	Optometrist	$0	$3.6M

State Of Missouri — Billing Profile & Reimbursement Data

Sign up for State Of Missouri — Billing Profile & Reimbursement Data policy alerts

State Of Missouri — Billing Profile & Reimbursement Data

Sign up for State Of Missouri — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References