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

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

Pathways Of Idaho, LLC (NPI 1326466988)

Field	Value
Entity Type	Organization
Organization	Pathways Of Idaho, LLC
Address	545 N Benjamin Ln Ste 185
City	Boise
State	ID
ZIP	83704
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	April 1, 2014

Payer Source	Total Paid
Medicaid	$12M
Medicare	$0

Key Findings

PATHWAYS OF IDAHO is effectively a single-payer Medicaid operation: there is no Medicare billing on file while total Medicaid revenue is $12M. This concentration on Medicaid makes the provider's financial profile and network leverage tied closely to Medicaid policy, rates, and referrals rather than to Medicare business lines.

Revenue is highly concentrated in a small set of service codes: the top three Medicaid codes account for 60.2% of this provider’s Medicaid revenue, led by H0038 at 30.5%, followed by T1013 at 17.2% and H2017 at 12.5%. That concentration indicates most revenue derives from a few recurring, time-based community behavioral health services rather than from a broad mix of medical E/M or procedure codes.

The code-level mix points to a community/behavioral health operating model focused on peer support, communication access, and rehabilitation: H0038 (Self-help/peer services) is the single largest revenue driver, T1013 (sign language/oral interpretive services) is the second, and H2017 (psychosocial rehabilitation) is the third. Together these codes imply major capacity for group/peer programming, language/access supports, and structured psychosocial habilitation rather than physician-led specialty care.

On statewide competitive standing, PATHWAYS is dominant for several high-volume behavioral codes: H0038 ranks #1 of 114 providers in-state (100th percentile; extreme outlier), and the psychotherapy code 90834 appears as an extreme outlier as well (24.6K claims, $1.4M revenue; ranks #7 of 413 providers, 99th percentile). These ranks indicate the provider is a major statewide supplier of peer support and psychotherapy services.

Beyond the top three, the provider shows above‑typical scale in case management, assessment, and service planning: T1017 (targeted case management) accounts for 10.6% of revenue and ranks in the 94th percentile, H0032 (service plan development) and H0031 (mental health assessment) are each described as extreme outliers in rank. This suggests substantial infrastructure for care coordination and non-physician assessment/plan work.

Telehealth and access services are also material to the operation: T1014 (telehealth transmission) appears with 6.3K claims and $125.4K revenue and ranks #5 of 125 providers (97th percentile), while T1013 (interpretive services) is the second-largest revenue driver. High rankings on these codes indicate the provider delivers a sizable portion of services via telehealth and places heavy emphasis on language/access supports.

The provider’s dependence on a few time-based behavioral codes creates concentration risk: with the top three codes equaling 60.2% of Medicaid revenue and H0038 alone at $3.7M, changes to Medicaid reimbursement, code definitions, or referral patterns for these services would materially affect overall revenue. That concentrated profile also means payer negotiations and program-level contracts for these service lines will disproportionately influence financial performance.

PATHWAYS has an established operational tenure—NPI enumerated 2014-04-01 (~12 years ago)—which, combined with multiple extreme-outlier ranks in state comparisons, suggests the organization has grown or sustained high-volume behavioral and support services over a multi-year period. The longevity plus the concentration in peer, interpretive, and psychosocial services positions the provider as a mature, specialized community behavioral health agency in Idaho.

Medicaid: Complete Services Breakdown

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

23 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0038	Self‑help/peer services, per 15 minutes	34,810	$110	$3.7M
T1013	Sign language or oral interpretive services, per 15 minutes	25,690	$80	$2.1M
H2017	Psychosocial rehabilitation services, per 15 minutes	14,040	$110	$1.5M
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…	24,580	$60	$1.4M
T1017	Targeted case management, each 15 minutes	17,630	$70	$1.3M
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…	6,500	$60	$363.9K
S9485	Crisis intervention mental health services, per diem	850	$350	$294.6K
H0046	Mental health services, not otherwise specified	2,560	$110	$284.4K
T1016	Case management, each 15 minutes	2,830	$90	$240.7K
H0032	Mental health service plan development by non-physician	3,690	$50	$181K

Showing 1–10 of 23

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Pathways Of Idaho, LLC — 7 of 23 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

23 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5150	Unskilled respite care, not hospice; per 15 minutes	18	30	1,410	$80	$804.2K
H2017	Psychosocial rehabilitation services, per 15 minutes	19	140	2,000	$110	$633.3K
T1013	Sign language or oral interpretive services, per 15 minutes	2	40	960	$70	$461.2K
H0038	Self‑help/peer services, per 15 minutes	1	110	1,730	$90	$436.4K
S9485	Crisis intervention mental health services, per diem	6	10	960	$350	$350.4K
T1017	Targeted case management, each 15 minutes	12	190	1,060	$60	$221.8K
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…	426	670	740	$40	$193.6K
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…	57	620	560	$60	$191.8K
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…	7	410	740	$60	$174.3K
S9480	Intensive outpatient psychiatric services, per diem	2	10	340	$150	$116.2K

Showing 1–10 of 23

Nearby Providers

Other providers in the same ZIP code as Pathways Of Idaho, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Full Circle Health, Inc.	ID	Federally Qualified Health Center (FQHC)	$0	$53.3M
Community Connections, Inc	ID	Case Management Agency	$0	$30M
K A Health Services LLC	ID	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$13.9M
County Of Ada	ID	Land Ambulance	$2M	$11.4M
Developmental Concepts, Inc.	ID	Developmental Disabilities Clinic/Center	$0	$13.2M
Havenwood Caregiver Services Of Idaho, LLC	ID	In Home Supportive Care Agency	$0	$10.7M
Living Independently Forever, Inc.	ID	Developmentally Disabled Services Day Training Agency	$0	$9.8M
Community Partnerships Of Idaho, Inc.	ID	Developmental Disabilities Clinic/Center	$0	$7.6M
All Horizons Inc	ID	Mental Health Counselor	$0	$6.7M
Ascent Behavioral Health Services	ID	Community/Behavioral Health Agency	$0	$4.7M

Pathways Of Idaho, LLC — Billing Profile & Reimbursement Data

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Pathways Of Idaho, LLC — 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