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

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

Stonington Behavioral Health Inc (NPI 1225097231)

Key Findings

Field	Value
Entity Type	Organization
Organization	Stonington Behavioral Health Inc
Address	75 Swantown Hill Rd
City	North Stonington
State	CT
ZIP	06359
Taxonomy	Psychiatric Hospital
NPI Enumerated	March 20, 2006

Payer Source	Total Paid
Medicaid	$51M
Medicare	$0

STONINGTON BEHAVIORAL HEALTH INC is effectively a Medicaid-focused psychiatric hospital: there is no Medicare billing on file while reported Medicaid revenue totals $51M, indicating the provider operates almost entirely within the state Medicaid market rather than as a dual-payer provider. The organization’s NPI was enumerated ~20 years ago (2006-03-20), showing long tenure in the market which may support established referral relationships and service capacity. The provider’s Medicaid revenue is highly concentrated in three procedure lines: H0015, H2013, and H0011 together account for 97.5% of its total Medicaid revenue, signaling a narrow service mix centered on behavioral health and substance use treatment rather than broad outpatient medical care. H0015 (intensive outpatient substance use services) is the largest single revenue driver at $29M and represents 56.9% of this provider’s Medicaid revenue; the provider ranks #1 of 74 in-state for H0015 and is described as an extreme outlier, indicating dominant statewide volume for intensive outpatient addiction treatment. H2013 (psychiatric health facility per diem) contributes $11.7M or 22.9% of Medicaid revenue and ranks #1 of 6 in-state for that code, reflecting substantial inpatient/residential psychiatric capacity relative to peers and a competitive position among facilities that bill per diem psychiatric services. H0011 (acute detoxification residential addiction program) contributes $9M or 17.7% of Medicaid revenue and ranks #1 of 7 in-state, a placement described as typical for that code but still confirming that residential detox is a material part of the provider’s business. Routine evaluation-and-management office codes (for example 99213, 99204 and smaller volumes of 99202/99212/99214/99203) together represent only a small share of Medicaid revenue (individual revenues listed range from $30.5K to $730.3K), indicating that outpatient E/M visits are minor components of overall billing compared with intensive substance use and psychiatric facility services. Several ancillary mental health codes show negligible or zero payment ($0 reported for H0047 and H0035 in the dataset), suggesting either non-reimbursed reporting, alternative funding streams, or low-volume activity for those specific program codes within this provider’s mix rather than material revenue sources.

Medicaid: Complete Services Breakdown

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

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	208,710	$140	$29M
H2013	Psychiatric health facility service, per diem	75,690	$150	$11.7M
H0011	Alcohol and/or drug services; acute detoxification (hospital inpatient) per diem	21,760	$410	$9M
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…	10,900	$70	$730.3K
99204	The provider sees a new 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 provider…	3,000	$150	$446.4K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	640	$50	$30.5K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	970	$30	$29.2K
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…	250	$100	$24.7K
99203	The provider sees a new 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 provider…	210	$80	$16K
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	90	$20	$1.5K

Showing 1–10 of 12

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Connecticut Distribution

Stonington Behavioral Health Inc — 3 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

12 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0011	Alcohol and/or drug services; acute detoxification (hospital inpatient) per diem	1	10	15,610	$490	$6.9M
H2013	Psychiatric health facility service, per diem	1	10	4,060	$140	$2.3M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	12	10	2,820	$160	$1.6M
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	70	3,710	$120	$1.6M
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…	1,068	1,590	740	$50	$331.8K
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…	179	1,710	750	$30	$243.3K
99203	The provider sees a new 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 provider…	236	480	200	$60	$112.1K
99204	The provider sees a new 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 provider…	38	480	150	$90	$100.9K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	42	180	120	$40	$40.1K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	141	580	230	$20	$32.8K

Showing 1–10 of 12

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Thomas Defanti	CT	Addiction Medicine (Psychiatry & Neurology) Physician	$0	$3.6M
Behavioral Transformations Of Nc	CT	Community/Behavioral Health Agency	$0	$1.7M

Stonington Behavioral Health Inc — Billing Profile & Reimbursement Data

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Stonington Behavioral Health Inc — 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

Nearby Providers

Frequently Asked Questions

References