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NPI 1306167713 · Raleigh, NC · Community/Behavioral Health Agency
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Easter Seals Ucp North Carolina & Virginia, Inc. is a community/behavioral health agency provider located in Raleigh, North Carolina. This profile covers 0 Medicare and 32 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Easter Seals Ucp North Carolina & Virginia, Inc. |
| Address | 5000 Falls Of Neuse Rd Ste 300 |
| City | Raleigh |
| State | NC |
| ZIP | 27609 |
| Taxonomy | Community/Behavioral Health Agency |
| NPI Enumerated | June 21, 2010 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $58.3M |
| Medicare | $0 |
This provider is effectively single‑payer: there is no Medicare billing on file and all reported lifetime federal revenue is Medicaid, totaling $58.3M. The absence of Medicare activity combined with sizable Medicaid receipts indicates operational focus and financial dependence on state Medicaid programs rather than fee‑for‑service Medicare markets.
Revenue is highly concentrated: the precomputed top 3 Medicaid codes by revenue account for 48.4% of this provider's total Medicaid revenue. Those top contributors are H0040 ($13.8M, 23.7%), H2022 ($7.6M, 13.1%), and S5145 ($6.7M, 11.6%), which together drive nearly half of the $58.3M portfolio and imply meaningful exposure to changes in reimbursement or utilization for those specific service lines.
The code mix points to a programmatic, community‑behavioral health operation centered on long‑duration, per‑diem and per‑unit support services rather than episodic medical encounters. High volumes in H0040 (Assertive community treatment, per diem), H2022 (Community‑based wrap‑around, per diem), S5145 (Foster care, therapeutic, child; per diem) and multiple habilitation and supported‑employment codes (T2013, T2012, H2023) indicate the organization runs sustained care programs, waiver services, and workforce supports rather than primarily office‑based E/M care.
Competitive standing varies by service line. For H0040 the provider ranks #12 of 119 (91th percentile) and is described as notably above typical state volume for this code, signifying a meaningful regional presence in assertive community treatment. H2023 (supported employment) is a pronounced strength: the provider ranks #3 of 66 (97th percentile) and is labeled an extreme outlier, far above typical state volume for this code, indicating market leadership in that niche.
For several other high‑revenue codes the provider is a modest or typical participant within the state rather than a dominant player. Examples include H2022 (ranks #17 of 216, described as typical, unremarkable volume for this code), S5145 (ranks #26 of 63, 60th percentile, typical), and T2013 (ranks #70 of 185, 63th percentile, typical). These placements imply regional depth in select programs but overall mixed competitive positioning across Medicaid service lines.
Unit payment levels and service units underscore labor‑ and program intensity: average paid per claim is $243 for H0040 and $237 for H2022 (both per diem), $153 for S5145 (per diem), and $150 for T2013 (per hour). These payment patterns—per‑diem and per‑15‑minute structures for many top codes—are consistent with staff‑delivered community supports and sustained care models rather than brief office visits.
Clinical psychotherapy and evaluation codes are present but secondary to programmatic supports. For example, 90837 generates $1.4M (2.4% of Medicaid revenue) and 90791 generates $115.5K (0.2%), showing that psychotherapy and psychiatric evaluation services exist in the mix but do not drive the provider’s Medicaid revenue base.
The organization shows longevity in the state Medicaid market: NPI enumerated on 2010-06-21 (~16 years ago), indicating an established operating history that aligns with the scale of programmatic services reported. That tenure, combined with concentrated revenue in a few programmatic codes, suggests operational stability but also exposure to policy or rate changes affecting those dominant service lines.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
32 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| H0040 | Assertive community treatment program, per diem | 56,870 | $240 | $13.8M |
| H2022 | Community-based wrap-around services, per diem | 32,260 | $240 | $7.6M |
| S5145 | Foster care, therapeutic, child; per diem | 44,020 | $150 | $6.7M |
| T2013 | Habilitation, educational, waiver; per hour | 42,250 | $150 | $6.3M |
| T2012 | Habilitation, educational; waiver, per diem | 23,810 | $160 | $3.8M |
| H2023 | Supported employment, per 15 minutes | 23,980 | $150 | $3.7M |
| H2033 | Multisystemic therapy for juveniles, per 15 minutes | 8,630 | $370 | $3.2M |
| H2025 | Ongoing support to maintain employment, per 15 minutes | 19,860 | $150 | $3.1M |
| H2015 | Comprehensive community support services, per 15 minutes | 19,670 | $130 | $2.6M |
| 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… | 17,570 | $80 | $1.4M |
Showing 1–10 of 32
How this provider's Medicaid billing volume and revenue compare to other North Carolina providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. North Carolina median
32 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| T2013 | Habilitation, educational, waiver; per hour | 70 | 190 | 29,090 | $150 | $9.1M |
| H2016 | Comprehensive community support services, per diem | 58 | 70 | 28,040 | $220 | $8.2M |
| S5145 | Foster care, therapeutic, child; per diem | 26 | 60 | 27,280 | $160 | $7.2M |
| T2012 | Habilitation, educational; waiver, per diem | 50 | 110 | 21,340 | $180 | $6.1M |
| H0040 | Assertive community treatment program, per diem | 12 | 120 | 15,180 | $230 | $5M |
| T2021 | Day habilitation, waiver; per 15 minutes | 148 | 200 | 25,740 | $130 | $4.6M |
| H2033 | Multisystemic therapy for juveniles, per 15 minutes | 4 | 20 | 3,620 | $390 | $3.9M |
| H2022 | Community-based wrap-around services, per diem | 17 | 220 | 3,330 | $290 | $3.3M |
| H2015 | Comprehensive community support services, per 15 minutes | 78 | 250 | 10,060 | $130 | $2.4M |
| T1019 | Personal care services, per 15 minutes, 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… | 48 | 80 | 2,380 | $160 | $1.8M |
Showing 1–10 of 32
Other providers in the same ZIP code as Easter Seals Ucp North Carolina & Virginia, Inc., ranked by combined Medicare and Medicaid revenue.
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