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

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

Tri-county Mental Health Services (NPI 1215979158)

Field	Value
Entity Type	Organization
Organization	Tri-county Mental Health Services
Address	1155 Lisbon Street
City	Lewiston
State	ME
ZIP	04241
Taxonomy	Mental Health Counselor
NPI Enumerated	June 12, 2006

Payer Source	Total Paid
Medicaid	$40.1M
Medicare	$0

Key Findings

This provider is effectively single‑payer: there is no Medicare billing on file while Medicaid billing totals $40.1M, so Medicaid accounts for the entire documented public‑payer revenue base. Analysts should treat TRI-COUNTY MENTAL HEALTH SERVICES as Medicaid-dependent when modeling payer risk or network contracting impact.

Revenue is highly concentrated: the top three Medicaid codes — T1020 ($17M, 42.4%), H0040 ($7.1M, 17.7%) and T2021 ($5.2M, 13.0%) — together account for 73.0% of the provider's total Medicaid revenue. This concentration means changes to reimbursement or utilization for those specific service lines would disproportionately affect overall revenue.

The code mix indicates a community‑based behavioral health and long‑term support operation: T1020 (personal care services, per diem), H0040 (assertive community treatment, per diem) and T2021 (day habilitation, per 15 minutes) are the top revenue drivers, supplemented by H0004 (behavioral health counseling and therapy, per 15 minutes) at $4.7M (11.6%). Together these codes suggest an operational footprint focused on per‑diem residential and wraparound community supports plus time‑based counseling services rather than short episodic medical care.

Competitive standing varies by service line. For T1020 the provider ranks #12 of 21 in‑state (45th percentile), a mid‑level participant; for H0040 it ranks #3 of 9 (75th percentile), indicating above‑typical scale in assertive community treatment; and for T2021 it ranks #15 of 72 (80th percentile), showing strong placement among day‑habilitation providers in Maine.

TRI-COUNTY holds a notable statewide position for behavioral health counseling: H0004 is $4.7M (11.6% of Medicaid revenue) and ranks #9 of 290 providers in‑state (97th percentile). That rank positions the provider as a major counseling/therapy supplier within the state even if overall Medicaid revenue is concentrated in a few per‑diem programs.

Tenure is long-standing: the NPI was enumerated on 2006-06-12 (~20 years ago), indicating the organization has an established presence and multi-year claims history for payers to examine when assessing utilization trends or contract performance.

Operationally the provider appears to rely more on per‑diem and program‑style billing than on brief office visits: large per‑diem codes (T1020, H0040, H0019) and habilitation/day services (T2021) dominate revenue while typical E/M and psychotherapy CPTs (e.g., 99214, 90837) account for very small shares of revenue. This mix implies capacity, staffing and care coordination geared toward sustained community supports rather than high volumes of short outpatient encounters.

Secondary and lower‑revenue codes (for example H2010 $666.3K; H2019 $159.9K; 99408 $45.8K; Q3014 $1.9K) are generally labeled in the source as "typical, unremarkable volume" within the state, indicating no immediate statistical outlier flags outside the top revenue drivers. Those smaller lines provide service breadth but do not materially change the Medicaid‑revenue concentration profile.

Medicaid: Complete Services Breakdown

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

20 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1020	Personal care services, per diem, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	7,500	$2,270	$17M
H0040	Assertive community treatment program, per diem	99,660	$70	$7.1M
T2021	Day habilitation, waiver; per 15 minutes	47,680	$110	$5.2M
H0004	Behavioral health counseling and therapy, per 15 minutes	61,320	$80	$4.7M
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	7,490	$500	$3.8M
H2033	Multisystemic therapy for juveniles, per 15 minutes	2,300	$470	$1.1M
H2010	Comprehensive medication services, per 15 minutes	4,240	$160	$666.3K
H2019	Therapeutic behavioral services, per 15 minutes	1,900	$80	$159.9K
H2011	Crisis intervention service, per 15 minutes	620	$150	$92.5K
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	190	$470	$89.7K

Showing 1–10 of 20

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

Tri-county Mental Health Services — 1 of 20 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

20 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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	18	30	13,990	$560	$23.9M
T1020	Personal care services, per diem, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	12	20	8,350	$340	$9.2M
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	10	10	5,380	$590	$6.3M
H0040	Assertive community treatment program, per diem	3	10	48,840	$80	$5.6M
T2021	Day habilitation, waiver; per 15 minutes	15	70	13,340	$200	$5.1M
H2011	Crisis intervention service, per 15 minutes	12	10	7,180	$310	$4.7M
H2018	Psychosocial rehabilitation services, per diem	7	10	28,460	$110	$3.3M
H2033	Multisystemic therapy for juveniles, per 15 minutes	3	10	2,390	$490	$3M
T2017	Habilitation, residential, waiver; 15 minutes	33	30	8,960	$260	$3M
H2010	Comprehensive medication services, per 15 minutes	23	50	3,690	$130	$1.6M

Showing 1–10 of 20

Tri-county Mental Health Services — Billing Profile & Reimbursement Data

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Tri-county Mental Health Services — 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

Frequently Asked Questions

References