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

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

Family Counseling Center, Inc (NPI 1306388525)

Field	Value
Entity Type	Organization
Organization	Family Counseling Center, Inc
Address	925 Highway V V
City	Kennett
State	MO
ZIP	63857
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	November 7, 2016

Payer Source	Total Paid
Medicaid	$284.1M
Medicare	$0

Key Findings

This provider is effectively a single‑payer Medicaid operation: Medicare billing is none (no Medicare billing on file) while lifetime Medicaid revenue is $284.1M, indicating the organization’s entire reported payer volume in the dataset comes from Medicaid programs. Analysts should treat Medicare-related comparisons as not applicable for this entity because no Medicare claims are on file.

Revenue is extremely concentrated in the Medicaid certified community behavioral health clinic per‑diem code: T1040 accounts for $283.3M (99.7% of this provider's total Medicaid revenue) and the precomputed top‑3 Medicaid codes together account for 99.9% of Medicaid revenue. This degree of concentration exposes the provider’s financial profile to changes in per‑diem policy or CCBHC contracting.

The code mix and volumes indicate the provider operates as a comprehensive community behavioral health clinic: the dominant T1040 per‑diem payment is supported by very large claim counts for programmatic service codes (for example H0036: 490.7K claims, $0 avg paid/claim, $0 revenue; H2017: 399.8K claims, $0 avg paid/claim, $0 revenue; H2012: 124.2K claims, $0 avg paid/claim, $0 revenue). The presence of many high‑volume H‑codes alongside the T1040 per‑diem is consistent with delivery of bundled, multi‑modal community behavioral health services rather than standalone fee‑for‑service line items.

Competitive standing for the T1040 per‑diem is strong in absolute terms: T1040 revenue ranks #3 of 31 providers in‑state (93th percentile; typical, unremarkable volume for this code), making the organization one of the top in‑state billers for certified community behavioral health clinic services. At the same time the dataset’s characterization as "typical, unremarkable" suggests the provider is large but not an extreme outlier for CCBHC per‑diem billing within Missouri.

Several CPT/HCPCS outpatient visit and psychotherapy codes are unusually high relative to peers and should be flagged for capacity and utilization analysis: 99213 shows 53.6K claims for $214.4K revenue (0.1% of Medicaid revenue) and ranks #23 of 4312 providers in‑state (99th percentile; extreme outlier, far above typical state volume for this code), while 90832 reports 25.9K claims for $181.4K revenue (0.1% of Medicaid revenue) and ranks #5 of 391 providers in‑state (99th percentile; notably above typical state volume for this code). These patterns point to substantial outpatient evaluation/management and shorter psychotherapy activity beyond the per‑diem program.

Multiple psychotherapy and E/M codes (90834, 90837, 99212, 99214 and evaluation codes 90791/90792) also appear at high percentiles (many at or above the 97th–99th percentiles) even though each contributes only a small share of total Medicaid revenue; this suggests high encounter volumes with low per‑claim payments and a clinical model that blends per‑diem program billing with frequent brief encounters. For payers and competitors, that mix implies operational capacity in both scheduled outpatient psychotherapy and programmatic community services.

The dataset shows many programmatic behavioral health codes with large claim counts but recorded $0 avg paid/claim (for example H0036, H2017, H0005, H0038 and others), which is consistent with those services being reimbursed as part of bundled per‑diem arrangements such as T1040 rather than as separately paid fee‑for‑service items. Contract reviewers should therefore inspect rate schedules and bundling rules with the state to understand where payments are aggregated and how utilization maps to reimbursements.

Provider tenure in the data is established: NPI enumerated 2016-11-07 (~10 years ago), indicating about a decade of activity under the current NPI. That duration, combined with the concentrated Medicaid revenue and large claim volumes, marks this organization as an established Medicaid behavioral health operator in Missouri whose performance should be evaluated primarily through Medicaid program and CCBHC metrics rather than Medicare comparisons.

Medicaid: Complete Services Breakdown

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

37 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1040	Medicaid certified community behavioral health clinic services, per diem	1,085,590	$260	$283.3M
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…	53,600	$1	$214.4K
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…	25,910	$10	$181.4K
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…	17,040	$10	$102.2K
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…	6,610	$10	$52.9K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	9,360	$10	$46.8K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	3,100	$10	$43.4K
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…	3,030	$10	$42.5K
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…	6,850	$10	$41.1K
99202	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves straightforward medical decision making, and/or the provider…	80	$10	$470

Showing 1–10 of 37

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Missouri Distribution

Family Counseling Center, Inc — 7 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Missouri

Full comparison — all codes billed, vs. Missouri median

37 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1040	Medicaid certified community behavioral health clinic services, per diem	3	30	198,100	$260	$125.7M
H0037	Community psychiatric supportive treatment program, per diem	13	20	56,420	$120	$11.7M
H0036	Community psychiatric supportive treatment, face-to-face, per 15 minutes	4	20	214,040	$20	$10.8M
H2036	Alcohol and/or other drug treatment program, per diem	4	10	17,770	$200	$7.4M
H2015	Comprehensive community support services, per 15 minutes	7	20	4,550	$50	$2.5M
H2017	Psychosocial rehabilitation services, per 15 minutes	2	20	40,460	$20	$2M
H2012	Behavioral health day treatment, per hour	2	10	33,050	$30	$1.9M
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…	5	10	1,150	$160	$1.4M
H0001	Alcohol and/or drug assessment	6	10	380	$280	$1.1M
H0004	Behavioral health counseling and therapy, per 15 minutes	8	40	3,680	$30	$978K

Showing 1–10 of 37

Nearby Providers

Other providers in the same ZIP code as Family Counseling Center, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tri-county Group Xv, Inc.	MO	Home Health Agency	$0	$113.1M
Bootheel Area Independent Living Services, Inc.	MO	Home Health Agency	$0	$58.9M
Visiting Nurse Association Of Southeast Missouri Inc	MO	Home Health Agency	$0	$26.1M
Hope@home LLC	MO	Home Health Agency	$0	$6.2M
Crosstree Healthcare LLC	MO	Assisted Living Facility	$0	$5.5M
Visiting Nurse Association Of Southeast Missouri Inc	MO	Home Health Agency	$0	$4.6M
Visiting Nurse Association Of Southeast Missouri Inc	MO	Home Health Agency	$0	$4.5M
Dunklin Day Activity Center	MO	Developmentally Disabled Services Day Training Agency	$0	$3.9M
Jackie Sutherland	MO	Internal Medicine Physician	$101.3K	$162.4K
Dave Jain	MO	Internal Medicine Physician	$207.1K	$0

Family Counseling Center, Inc — Billing Profile & Reimbursement Data

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Family Counseling Center, 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

Nearby Providers

Frequently Asked Questions

References