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

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

Macomb County Community Mental Health (NPI 1255385399)

Field	Value
Entity Type	Organization
Organization	Macomb County Community Mental Health
Address	43740 N Groesbeck Hwy
City	Clinton Twp
State	MI
ZIP	48036
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	May 22, 2006

Payer Source	Total Paid
Medicaid	$299.9M
Medicare	$0

Key Findings

This provider is effectively single-payer in scale: there is no Medicare billing on file while lifetime Medicaid revenue is $299.9M, indicating the organization’s operations and financial footprint are concentrated in Medicaid programs rather than Medicare. Analysts should treat Macomb County Community Mental Health as a Medicaid-focused community behavioral health organization for payer mix and reimbursement modeling purposes.

Revenue is heavily concentrated in a small set of Medicaid codes: the top three Medicaid codes (T1040, T1017, 99214) account for 57.1% of the provider’s total Medicaid revenue. Those three contributions are T1040 at $79.1M (27.1%), T1017 at $63.9M (21.9%), and 99214 at $23.5M (8.0%), signaling material dependence on certified community behavioral health clinic per-diem services, targeted case management, and mid-complexity outpatient E/M visits.

The code mix signals a comprehensive community mental health operations model: dominant revenue from T1040 (Medicaid certified community behavioral health clinic per diem) and large volumes of T1017 and T1016 (targeted/case management) show an emphasis on day/per-diem clinic programming plus intensive care coordination. Significant billing for psychotherapy and psychiatric evaluation codes (90837, 90834, 90791, 90792) and for community-based services (H0039, H2030, H2011, H2021) indicates the provider delivers both office-based clinical care and broad community/ACT supports.

State-level competitive standing is strong for multiple lines of service: T1040 ranks #3 of 42 in-state (95th percentile) and T1017 ranks #5 of 175 in-state (98th percentile, labeled an extreme outlier), while 99214 ranks #25 of 4380 in-state (99th percentile, extreme outlier). These rank/percentile positions show Macomb County Community Mental Health is a major Medicaid provider in Michigan for certified community behavioral health clinic services, targeted case management, and higher-complexity outpatient E/M visits.

Psychotherapy and psychiatric evaluation volumes are unusually high versus peers: 90834 (51.1K claims, $8.3M) and 90837 (34K claims, $8.6M) both sit in the 99th percentile or are flagged as extreme outliers, and 90791 is a 100th percentile extreme outlier with $7.3M revenue. This concentration of billed psychotherapy and evaluation encounters implies significant clinical capacity (therapists and prescribers) relative to other in-state providers.

Community-based and wrap-around program billing is substantial and diversified: meaningful revenue and claims appear for H0039 (Assertive community treatment, $15.7M), H2030 (Clubhouse services, $7.2M), H2011 (Crisis intervention, $5M), H2021 (Wrap-around services, $2.6M) and peer/support services like H0038. The breadth across ACT, clubhouse, crisis, wrap-around, and peer services indicates an integrated menu of community supports rather than a narrow outpatient-only operation.

Several specific codes are statistical outliers or notably above typical state volume, highlighting programmatic strengths: 90791 is a 100th percentile extreme outlier, T1017 is characterized as an extreme outlier (98th percentile), and 96372 is an extreme outlier (98th percentile) with $3.1M revenue. These outlier flags—across case management, psychiatric evaluation, and injectable procedure volumes—suggest concentrated operational expertise in those modalities that differentiate this provider from typical in-state peers.

The provider has an established operational tenure: NPI enumerated 2006-05-22 (~20 years ago), which supports the interpretation that these Medicaid-focused service lines and high-volume program footprints reflect sustained activity and market presence rather than a short-term or nascent operation. This longevity, combined with high statewide ranks for core codes, strengthens the case that Macomb County Community Mental Health is an entrenched Medicaid behavioral health hub in its region.

Medicaid: Complete Services Breakdown

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

55 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1040	Medicaid certified community behavioral health clinic services, per diem	364,560	$220	$79.1M
T1017	Targeted case management, each 15 minutes	226,420	$280	$63.9M
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…	78,750	$300	$23.5M
H0039	Assertive community treatment, face-to-face, per 15 minutes	54,600	$290	$15.7M
T1016	Case management, each 15 minutes	47,700	$260	$12.4M
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…	34,050	$250	$8.6M
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…	51,110	$160	$8.3M
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…	10,760	$720	$7.8M
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	16,560	$440	$7.3M
H2030	Mental health clubhouse services, per 15 minutes	38,160	$190	$7.2M

Showing 1–10 of 55

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Michigan Distribution

Macomb County Community Mental Health — 11 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. Michigan median

55 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1017	Targeted case management, each 15 minutes	5	180	10,890	$210	$8.1M
T1040	Medicaid certified community behavioral health clinic services, per diem	3	40	30,550	$80	$6.8M
H2015	Comprehensive community support services, per 15 minutes	230	610	14,740	$90	$6M
H0039	Assertive community treatment, face-to-face, per 15 minutes	9	70	20,710	$180	$5.1M
H0036	Community psychiatric supportive treatment, face-to-face, per 15 minutes	32	90	8,750	$300	$4.7M
T1016	Case management, each 15 minutes	10	120	8,060	$210	$3.4M
H2030	Mental health clubhouse services, per 15 minutes	17	60	22,740	$80	$2.3M
T2025	Waiver services; not otherwise specified (nos)	23	30	2,980	$100	$2.3M
T1005	Respite care services, up to 15 minutes	24	110	4,910	$80	$2.2M
H2019	Therapeutic behavioral services, per 15 minutes	4	30	3,330	$200	$1.6M

Showing 1–10 of 55

Nearby Providers

Other providers in the same ZIP code as Macomb County Community Mental Health, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lifelong Advocacy,inc	MI	Voluntary or Charitable Agency	$0	$78.8M
Medstar, Inc.	MI	Ambulance	$11.5M	$50.5M
Henry Ford Health Eastwood Behavioral Health	MI	Social Worker	$0	$25.2M
Macomb Family Services, Inc.	MI	Clinical Social Worker	$0	$20.2M
Arc Services Of Macomb, Inc	MI	Developmentally Disabled Services Day Training Agency	$0	$13.8M
Developmental Essential Services Inc	MI	Developmentally Disabled Services Day Training Agency	$0	$12.7M
Asc-tcg, LLC	MI	Ambulatory Surgical Clinic/Center	$407.7K	$0
Robert Franchi	MI	Ophthalmology Physician	$222.7K	$0
Rene Peleman	MI	Gastroenterology Physician	$151.5K	$0
Adam Feinstein	MI	Neuromusculoskeletal Medicine & OMM Physician	$146.5K	$0

Macomb County Community Mental Health — Billing Profile & Reimbursement Data

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Macomb County Community Mental Health — 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