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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Behavior Management Systems, Inc. (NPI 1295878122)

Field	Value
Entity Type	Organization
Organization	Behavior Management Systems, Inc.
Address	350 Elk St
City	Rapid City
State	SD
ZIP	57701
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	February 14, 2007

Payer Source	Total Paid
Medicaid	$19.8M
Medicare	$0

Key Findings

This entity has no Medicare billing on file and is effectively a Medicaid-focused provider: Total Medicaid revenue is $19.8M. The absence of Medicare activity indicates payer concentration in state Medicaid programs rather than dual-payer operations.

Revenue is highly concentrated in a narrow set of community behavioral health services: the precomputed top three Medicaid codes (H2021, H2016, H0039) account for 84.1% of this provider's total Medicaid revenue. Individually those codes generate $7.8M (H2021, 39.2%), $5.7M (H2016, 28.9%), and $3.2M (H0039, 16.0%).

The code mix points to an operation focused on intensive community-based behavioral health and mobile/ongoing support: H2021 (Community-based wrap-around services, per 15 minutes), H2016 (Comprehensive community support services, per diem), and H0039 (Assertive community treatment, face-to-face, per 15 minutes) dominate revenue, implying programs such as wrap-around services, per-diem community supports, and ACT teams that bill high-frequency time-based units. Psychotherapy and medication-management codes appear supplemental to these core community services.

Competitive standing by code is mixed within-state: H2021 ranks #2 of 11 providers (90th percentile) and H2016 ranks #3 of 11 providers (80th percentile), indicating a strong statewide position for the two largest service lines. In contrast, H0039 ranks #4 of 5 providers (25th percentile), suggesting that while H0039 contributes materially to this provider's revenue, peer activity for that specific ACT code is limited and this provider is not a top state performer on that measure.

There are notable statistical outliers in non-core but strategically important services: 90863 (medication management after psychotherapy) produced $1.1M and represents 5.5% of Medicaid revenue while ranking #1 of 12 providers in-state (100th percentile; notably above typical state volume). Similarly, 90791 (psychiatric evaluation) generated $383.1K (1.9% of revenue) and ranks #1 of 68 providers (100th percentile; extreme outlier), indicating exceptional state-level volume for initial psychiatric evaluations relative to peers.

The broader service portfolio includes psychotherapy and outpatient E/M activity that complements community supports: 90832 accounted for $651.9K (3.3% of revenue) and ranks #6 of 72 providers (93rd percentile), while common E/M and telehealth site fees (99214, 99213, Q3014) appear at modest revenue levels. This mix suggests blended delivery of time-based community interventions with clinic-based psychotherapy and medication services.

From an operational and revenue-risk perspective, dependence on a few high-volume time-based community codes (H2021, H2016, H0039) means reimbursement or authorization changes to those specific services could materially affect the provider’s $19.8M Medicaid base. Many of the top-paying codes are billed per 15 minutes or per diem, which requires sustained utilization to support current revenue levels and could be sensitive to service-duration controls.

The provider is an established statewide participant with a long tenure: NPI enumerated 2007-02-14 (~19 years ago). Its $19.8M in Medicaid revenue and multiple top-percentile ranks in-state position it as a significant community/behavioral health agency in South Dakota, though its competitive strength varies by specific service line.

Medicaid: Complete Services Breakdown

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

18 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2021	Community-based wrap-around services, per 15 minutes	76,090	$100	$7.8M
H2016	Comprehensive community support services, per diem	74,230	$80	$5.7M
H0039	Assertive community treatment, face-to-face, per 15 minutes	39,100	$80	$3.2M
90863	The provider prescribes and reviews medications for pharmacological management after psychotherapy services at the same encounter.	15,900	$70	$1.1M
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…	7,850	$80	$651.9K
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…	4,740	$90	$407.6K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	4,030	$100	$383.1K
H2012	Behavioral health day treatment, per hour	1,420	$220	$309.9K
W0037	N/A	1,840	$70	$121.6K
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…	4,270	$20	$98.1K

Showing 1–10 of 18

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Behavior Management Systems, Inc. — 2 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

18 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2016	Comprehensive community support services, per diem	3	10	29,180	$80	$3.6M
H2021	Community-based wrap-around services, per 15 minutes	2	10	47,600	$90	$3.5M
H0039	Assertive community treatment, face-to-face, per 15 minutes	4	10	45,430	$80	$3.3M
90863	The provider prescribes and reviews medications for pharmacological management after psychotherapy services at the same encounter.	1	10	5,650	$90	$550.2K
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…	3	10	3,370	$130	$538.5K
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…	164	340	1,010	$100	$511K
H2012	Behavioral health day treatment, per hour	2	10	1,150	$180	$324.5K
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…	39	260	860	$80	$222.6K
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…	6	70	200	$80	$176.7K
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…	141	190	430	$90	$154.1K

Showing 1–10 of 18

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Kay Foland	SD	Psychiatric/Mental Health Nurse Practitioner	$43.9K	$0
Janell Rubelt	SD	Nurse Practitioner	$21K	$0
Katie Robinson	SD	Nurse Practitioner	$8.1K	$0
Lisa Kautzman	SD	Psychiatric/Mental Health Nurse Practitioner	$2.6K	$0
Steven Dary	SD	Psychiatric/Mental Health Nurse Practitioner	$120	$0

Nearby Providers

Other providers in the same ZIP code as Behavior Management Systems, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Monument Health Rapid City Hospital, Inc	SD	Multi-Specialty Clinic/Center	$0	$18.7M
Monument Health Rapid City Hospital, Inc.	SD	General Acute Care Hospital	$0	$11.5M
Community Health Center Of The Black Hills Inc	SD	Federally Qualified Health Center (FQHC)	$0	$10.2M
Jrk Services, Inc	SD	Home Health Agency	$0	$10.1M
Black Hills Pediatrics, LLP	SD	Pediatrics Physician	$0	$9.7M
Rapid City Emergency Services PA	SD	Emergency Medicine Physician	$0	$8.2M
Wellspring Inc.	SD	Psychiatry Physician	$0	$7.4M
Prema Abraham	SD	Retina Specialist (Ophthalmology) Physician	$7.1M	$0
Radiology Associates Prof, LLC	SD	Diagnostic Radiology Physician	$0	$5.3M
Monument Health Rapid City Hospital, Inc.	SD	Multi-Specialty Clinic/Center	$0	$5.2M

Behavior Management Systems, Inc. — Billing Profile & Reimbursement Data

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Behavior Management Systems, 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

Related Providers

Nearby Providers

Frequently Asked Questions

References