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NPI 1205360153 · Fargo, ND · Methadone Clinic
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Community Medical Services Montana Private LLC is a methadone clinic provider located in Fargo, North Dakota. This profile covers 3 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.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Community Medical Services Montana Private LLC |
| Address | 901 28th Street South |
| City | Fargo |
| State | ND |
| ZIP | 58103 |
| Taxonomy | Methadone Clinic |
| NPI Enumerated | April 18, 2017 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $8.9M |
| Medicare | $214.7K |
COMMUNITY MEDICAL SERVICES MONTANA PRIVATE LLC is registered as a Methadone Clinic in Fargo, ND with an NPI enumerated on 2017-04-18 (~9 years ago). Its lifetime billing is heavily skewed toward Medicaid ($8.9M) versus Medicare ($214.7K), indicating the provider operates primarily as an SUD/methadone treatment provider serving Medicaid populations rather than Medicare-heavy caseloads.
Medicare billing is concentrated in opioid treatment program (OTP) bundle and assessment codes, consistent with an OTP operation: G2067 (815 claims, $235 avg paid/claim, $191.5K revenue) alone represents 89.3% of this provider's Medicare revenue, and the three listed Medicare codes together account for 100.0% of total Medicare revenue. The presence of G2172 and G2077 shows the Medicare activity includes both demonstration-model integrated OUD payments and periodic OTP assessments in addition to routine methadone treatment.
Medicaid billing confirms a high-volume OTP and medication management focus: the top three Medicaid codes are H0016 (44.6K claims, $103 avg paid/claim, $4.6M revenue), H0020 (229.9K claims, $11 avg paid/claim, $2.5M revenue), and H2010 (89.1K claims, $11 avg paid/claim, $979.6K revenue), which together account for 91.7% of this provider's Medicaid revenue. These volumes indicate core business lines are ambulatory medical/somatic SUD services, methadone administration/dispensing, and billed medication services by time.
Revenue concentration is very high across both payers: the precomputed top-3 Medicare codes account for 100.0% of Medicare revenue while the top-3 Medicaid codes account for 91.7% of Medicaid revenue. This tight concentration around OTP and medication-management codes suggests the provider’s financial performance is closely tied to sustained demand and reimbursement stability for methadone/OTP services.
Nationally, the provider is a modest participant in Medicare OTP billing: G2067 ranks #315 of 830 providers nationally (62th percentile; typical, unremarkable volume), G2172 ranks #11 of 24 (57th percentile; typical, unremarkable volume), and G2077 ranks #83 of 352 (76th percentile; typical, unremarkable volume). Those percentiles indicate the provider’s Medicare footprint is unremarkable on a national scale and does not represent national dominance for these OTP codes.
State-level Medicaid positioning is strong and in some cases dominant: H0016 ranks #1 of 6 providers in-state (100th percentile; notably above typical state volume), H0020 ranks #1 of 5 providers in-state (100th percentile; typical, unremarkable volume), and H2010 ranks #1 of 5 providers in-state (100th percentile; typical, unremarkable volume). Additionally, psychotherapy code 90832 is an "extreme outlier, far above typical state volume" (6.8K claims, $405.2K revenue), signaling unusually high billed psychotherapy activity relative to in-state peers.
Ancillary service mix supports comprehensive OTP operations: substantial drug testing billing (80307: 3K claims, $74 avg paid/claim, $218.8K revenue; ranks #3 of 19 in-state, 89th percentile) and non-OTP outpatient E/M billing (99214: 757 claims, $64 avg paid/claim, $48.4K revenue) appear as meaningful secondary revenue streams. These ancillary codes reinforce that the site provides routine monitoring, toxicology screening, and some office-based follow-up in addition to methadone dispensing.
Given the NPI tenure (enumerated 2017-04-18 (~9 years ago)) and the sustained high volumes on key Medicaid lines (e.g., 229.9K H0020 claims and 44.6K H0016 claims), the provider appears to be an established, high-volume OTP operator in-state. The combination of Medicaid-dominant revenue and concentrated OTP coding suggests operational maturity in methadone dispensing and SUD medication services but also exposes the business to payer-specific policy or rate changes affecting those core codes.
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… | 820 | $240 | $191.5K |
| G2172 | All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project | 40 | $330 | $12.9K |
| G2077 | Periodic assessment; assessing periodically by an otp practitioner and includes a review of moud dosing, treatment response, other substance use disorder treatment needs, responses and… | 90 | $110 | $10K |
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.
10 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| H0016 | Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) | 44,560 | $100 | $4.6M |
| H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | 229,890 | $10 | $2.5M |
| H2010 | Comprehensive medication services, per 15 minutes | 89,050 | $10 | $979.6K |
| 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… | 6,750 | $60 | $405.2K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 2,960 | $70 | $218.8K |
| H2035 | Alcohol and/or other drug treatment program, per hour | 890 | $60 | $57K |
| 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… | 760 | $60 | $48.4K |
| H0001 | Alcohol and/or drug assessment | 40 | $130 | $5.4K |
| 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… | 30 | $30 | $840 |
| T1016 | Case management, each 15 minutes | 180 | $1 | $180 |
How this provider's Medicaid billing volume and revenue compare to other North Dakota providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. North Dakota median
10 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| H0016 | Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) | 1 | 10 | 9,500 | $90 | $1.4M |
| H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | 1 | 10 | 88,890 | $10 | $988.7K |
| H2010 | Comprehensive medication services, per 15 minutes | 1 | 10 | 73,500 | $10 | $459K |
| 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… | 61 | 170 | 300 | $100 | $415.8K |
| T1016 | Case management, each 15 minutes | 17 | 20 | 1,390 | $100 | $242.6K |
| H2035 | Alcohol and/or other drug treatment program, per hour | 7 | 20 | 590 | $90 | $206.4K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 3 | 20 | 920 | $30 | $111.2K |
| 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… | 2 | 30 | 260 | $60 | $55.1K |
| 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… | 14 | 20 | 260 | $20 | $18.4K |
| H0001 | Alcohol and/or drug assessment | 4 | 10 | 30 | $80 | $10.5K |
Other providers in the same ZIP code as Community Medical Services Montana Private LLC, ranked by combined Medicare and Medicaid revenue.
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