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

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

Generations Health Association, Inc. (NPI 1245212380)

Field	Value
Entity Type	Organization
Organization	Generations Health Association, Inc.
Address	5736 Manchester Hwy
City	Morrison
State	TN
ZIP	37357
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	November 15, 2005

Payer Source	Total Paid
Medicaid	$136.7M
Medicare	$0

Key Findings

This provider is effectively single‑payer: there is no Medicare billing on file, while total Medicaid revenue is $136.7M, indicating the organization’s entire reported federal program footprint is concentrated in Medicaid. Analysts should treat Medicaid as the primary — and for practical purposes only — payer when evaluating this entity’s scale and risk exposure.

Revenue is extremely concentrated in a small set of Medicaid codes: the top 3 Medicaid codes by revenue account for 98.1% of this provider's total Medicaid revenue. H0043 alone generates $125.2M (91.6% of Medicaid revenue), while S0280 contributes $7.7M (5.6%) and 99213 contributes $1.2M (0.8%), making the business highly dependent on a very small service set.

The code mix points to an operation centered on supported housing plus care coordination and routine outpatient visits. H0043 (Supported housing, per diem) dominating revenue suggests the provider primarily operates a supported housing model, while S0280 (Medical home program, comprehensive care coordination and planning, initial plan) and 99213 (office/outpatient E&M) indicate bundled care coordination and frequent low‑level E&M contacts are also core services. Together these codes suggest a service line strategy focused on housing‑based behavioral health supports with embedded care management.

Competitive standing on the dominant code is high but not singularly dominant statewide: for H0043 the provider ranks #4 of 20 in-state (84th percentile; typical, unremarkable volume). In plain terms, the organization is a major player in supported housing within the state but is not the top billing entity for that service, so peers or larger regional programs still hold meaningful market share.

For routine outpatient E&M, the provider is an extreme high‑volume outlier relative to most in-state peers: 99213 shows 68.3K claims and the provider ranks #58 of 4050 (99th percentile; notably above typical state volume). This suggests unusually large volumes of low‑complexity office visits and may reflect high visit frequency, large client panels, or integrated clinic activity co‑located with housing services.

The provider reports very large counts of coordinated‑care and related codes that show no fee‑for‑service revenue, signaling heavy involvement in non‑FFS care management structures. Examples include G9007 (41.4K claims, $0 avg paid/claim, $0 revenue) where the provider ranks #1 of 20 (100th percentile; extreme outlier), plus high claim counts for G9005 (53.9K claims, $0) and G9006 (54K claims, $0), indicating extensive reporting of coordinated care activities that do not translate to traditional Medicaid fee payments.

Operationally, the organization also bills substantial nonclinical support services tied to client access: A0110 shows 40.7K claims and $284.8K revenue, A0425 shows 21.5K claims and $86K revenue, and A0100 shows 14.7K claims and $14.7K revenue. These volumes underline a logistics and transportation component to their service model, consistent with a program that provides housing and community‑based supports.

The provider has long tenure in the Medicare/Medicaid ecosystem, with an NPI enumeration date of 2005-11-15 (~21 years ago). This extended operational history, combined with concentrated Medicaid revenue and high claim volumes on both housing and care coordination codes, suggests an established organization with entrenched Medicaid program participation and operational processes aligned to supported‑housing models.

Medicaid: Complete Services Breakdown

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
H0043	Supported housing, per diem	195,860	$640	$125.2M
S0280	Medical home program, comprehensive care coordination and planning, initial plan	87,700	$90	$7.7M
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…	68,290	$20	$1.2M
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…	21,160	$40	$825.1K
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…	34,050	$20	$715K
A0110	Non-emergency transportation and bus, intra or inter state carrier	40,680	$10	$284.8K
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…	5,410	$40	$216.5K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	3,950	$50	$213.2K
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…	7,470	$30	$209.2K
A0425	Ground mileage, per statute mile	21,490	$1	$86K

Showing 1–10 of 27

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Generations Health Association, Inc. — 1 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

27 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S0280	Medical home program, comprehensive care coordination and planning, initial plan	13	40	22,180	$140	$21.3M
H0043	Supported housing, per diem	4	20	69,350	$180	$18.6M
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…	21	360	350	$50	$414.4K
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…	139	440	530	$70	$282.3K
A0425	Ground mileage, per statute mile	72	340	6,120	$10	$280.5K
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…	16	300	480	$30	$221.2K
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…	415	3,760	610	$40	$202.3K
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…	58	4,050	620	$30	$183.9K
A0110	Non-emergency transportation and bus, intra or inter state carrier	23	200	4,240	$10	$183.4K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	23	310	110	$70	$142.8K

Showing 1–10 of 27

Generations Health Association, Inc. — Billing Profile & Reimbursement Data

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Generations Health Association, 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

Frequently Asked Questions

References