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.

Mainehealth (NPI 1265912067)

Field	Value
Entity Type	Organization
Organization	Mainehealth
Address	165 Lancaster St
City	Portland
State	ME
ZIP	04101
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	August 21, 2018

Payer Source	Total Paid
Medicaid	$115M
Medicare	$0

Key Findings

MAINEHEALTH is effectively a single-payer Medicaid provider at scale: there is no Medicare billing on file while Medicaid lifetime revenue is $115M, indicating the organization’s operations and revenue base are almost entirely Medicaid-dependent. This payer concentration should be front-of-mind for network planners and contract negotiators evaluating exposure to Medicaid policy or rate changes.

Revenue is highly concentrated in a small set of Medicaid codes: the top three codes (T1020, H2011, H2010) together account for 50.4% of the provider’s total Medicaid revenue. That concentration shows the financial profile is driven by a few high-impact service lines, which creates both focused operational scale and sensitivity to reimbursement or utilization shifts for those codes.

The top revenue-driving codes reflect a community and behavioral health operating model centered on personal care, crisis response, and medication management: T1020 (19.6% of Medicaid revenue; 112.5K claims, $200 avg paid/claim), H2011 (19.3%; 45.8K claims, $484 avg paid/claim), and H2010 (11.5%; 101.8K claims, $130 avg paid/claim) dominate the mix. The prevalence of per-diem and per-15-minute codes suggests a mix of both sustained, longitudinal support (personal care and per-diem services) and very high-volume, time-based clinical contacts (crisis intervention and medication services).

MAINEHEALTH occupies a leading position in multiple statewide service lines: T1020 ranks #2 of 21 providers in-state (95th percentile, notably above typical state volume), H2011 ranks #2 of 13 (92nd percentile, notably above typical state volume), H2010 ranks #2 of 49 (98th percentile, notably above typical state volume), and H0040 (Assertive community treatment) ranks #1 of 9 (100th percentile, notably above typical state volume). These ranks indicate the provider is a major competitor for high-acuity community behavioral services in Maine.

Operational scale is evident from claim volumes and unit payments across several high-use codes: H0040 has 164.8K claims at $79 avg paid/claim and H0004 (behavioral health counseling and therapy) has 100.1K claims at $63 avg paid/claim (H0004 ranks #5 of 290, 99th percentile). High claim counts for both time-based therapy and per-diem programs imply significant staffing, scheduling and care-coordination capacity to deliver outpatient and community-based services at scale.

The organization’s service breadth extends beyond the top three drivers into residential and wraparound care: H0019 (long-term residential) produced $12.7M (11.0% of Medicaid revenue) with 112.4K claims and ranks #4 of 28 (89th percentile), while H2012 (day treatment) and H2018 (psychosocial rehabilitation) also contribute meaningful volumes. This mix indicates MAINEHEALTH provides multiple levels of behavioral health care from counseling and day programs through residential care, supporting a continuum-of-care positioning.

Dependence on a handful of high-revenue codes creates a strategic risk/benefit tradeoff: the focus on T1020, H2011 and H2010 (together 50.4% of Medicaid revenue) likely delivers operational efficiencies and negotiating leverage for those service lines, but it also concentrates revenue exposure if state rate-setting or utilization trends change for these specific codes. Payers and provider finance teams should prioritize monitoring these code families for policy or utilization shifts.

MAINEHEALTH’s NPI was enumerated on 2018-08-21 (~8 years ago), so the provider is relatively established but not legacy-aged. Combined with the high statewide ranks and very large claim volumes for multiple behavioral codes, this tenure and utilization profile are consistent with a rapidly scaled, dominant Medicaid behavioral health provider within Maine rather than a small or nascent entrant.

Medicaid: Complete Services Breakdown

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

35 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…	112,460	$200	$22.5M
H2011	Crisis intervention service, per 15 minutes	45,840	$480	$22.2M
H2010	Comprehensive medication services, per 15 minutes	101,780	$130	$13.2M
H0040	Assertive community treatment program, per diem	164,800	$80	$13M
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	112,400	$110	$12.7M
H2021	Community-based wrap-around services, per 15 minutes	21,640	$400	$8.6M
H2012	Behavioral health day treatment, per hour	29,940	$260	$7.6M
H0004	Behavioral health counseling and therapy, per 15 minutes	100,100	$60	$6.3M
H2018	Psychosocial rehabilitation services, per diem	41,080	$80	$3.3M
H2033	Multisystemic therapy for juveniles, per 15 minutes	2,390	$650	$1.6M

Showing 1–10 of 35

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

Mainehealth — 3 of 25 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

35 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	4	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…	2	20	8,350	$340	$9.2M
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	6	10	5,380	$590	$6.3M
H0040	Assertive community treatment program, per diem	1	10	48,840	$80	$5.6M
H2021	Community-based wrap-around services, per 15 minutes	27	100	8,660	$290	$5.1M
H2012	Behavioral health day treatment, per hour	10	40	13,180	$230	$5.1M
H2011	Crisis intervention service, per 15 minutes	2	10	7,180	$310	$4.7M
H2018	Psychosocial rehabilitation services, per diem	4	10	28,460	$110	$3.3M
H2033	Multisystemic therapy for juveniles, per 15 minutes	2	10	2,390	$490	$3M
G9012	Other specified case management service not elsewhere classified	37	50	25,820	$80	$3M

Showing 1–10 of 35

Related Providers

Other providers that share a Tax Identification Number (TIN) with Mainehealth, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mainehealth	ME	General Acute Care Hospital	$0	$142.6M
Mainehealth	ME	General Acute Care Hospital	$0	$70.7M
Mainehealth	ME	General Acute Care Hospital	$0	$40M
Mainehealth	ME	General Acute Care Hospital	$0	$31.5M
Mainehealth	ME	General Acute Care Hospital	$0	$22.7M
Mainehealth	ME	Rural Health Clinic/Center	$0	$16.7M
Mainehealth	ME	Multi-Specialty Clinic/Center	$0	$10.9M
Mainehealth	ME	Rural Health Clinic/Center	$0	$10M
Mainehealth	ME	Rural Health Clinic/Center	$0	$9.8M
Mainehealth	ME	Rural Health Clinic/Center	$0	$9.6M

Nearby Providers

Other providers in the same ZIP code as Mainehealth, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Goodwill Industries Of Northern New England	ME	Comprehensive Outpatient Rehabilitation Facility (CORF)	$0	$106M
Maine Vocational Associates, Inc.	ME	Developmentally Disabled Services Day Training Agency	$0	$34.3M
Catholic Charities Maine	ME	Clinical Social Worker	$0	$17.7M
Spurwink Services Incorporated	ME	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$16.8M
Milestone Recovery	ME	Substance Abuse Rehabilitation Facility	$0	$8.8M
Portland Community Health Center	ME	Federally Qualified Health Center (FQHC)	$0	$7.4M
Black Bear Medical, Inc.	ME	Customized Equipment (DME)	$0	$7.4M
Usa Family Well Being Services LLC	ME	Community/Behavioral Health Agency	$0	$6.3M
City Of Portland	ME	Land Ambulance	$740.2K	$5.4M
Maine Behavioral Healthcare	ME	Community/Behavioral Health Agency	$0	$4.9M

Mainehealth — Billing Profile & Reimbursement Data

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Mainehealth — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References