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NPI 1356336903 · Barboursville, WV · Community/Behavioral Health Agency
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Prestera Center For Mental Health Services Inc is a community/behavioral health agency provider located in Barboursville, West Virginia. This profile covers 0 Medicare and 35 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 | Prestera Center For Mental Health Services Inc |
| Address | 99 Cracker Barrel Dr Ste 100 |
| City | Barboursville |
| State | WV |
| ZIP | 25504 |
| Taxonomy | Community/Behavioral Health Agency |
| NPI Enumerated | September 20, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $75.4M |
| Medicare | $0 |
This provider is effectively a Medicaid-centric operation: there is no Medicare billing on file while lifetime Medicaid revenue is $75.4M, indicating the organization’s financial scale is driven almost entirely by state Medicaid payments rather than Medicare. The absence of Medicare activity positions PRESTERA as a single‑payer (Medicaid) participant for the universe of claims in this dataset.
Revenue is highly concentrated in a small set of programmatic codes: the top three Medicaid codes account for 70.2% of the provider’s total Medicaid revenue. The leading entries are H2036 at $22.5M (29.9%), H0004 at $15.3M (20.3%), and H0040 at $15.1M (20.1%), which together form the backbone of the provider’s Medicaid receipts.
The code mix indicates a service model focused on community‑based behavioral health and substance use disorder programs: H2036 (AOD treatment, per diem) and H0040 (assertive community treatment, per diem) point to per‑diem, programmatic care delivery, while H0004 (behavioral health counseling and therapy, per 15 minutes) reflects very high-volume, billed psychotherapy/counseling sessions. This combination is consistent with an agency operating intensive outpatient and mobile/community treatment teams alongside high-throughput counseling services.
PRESTERA holds a dominant or near‑dominant competitive standing in several core Medicaid service lines statewide. H0004 ranks #1 of 166 providers in-state (100th percentile; labeled an extreme outlier) and H2036 ranks #2 of 35 (97th percentile; notably above typical state volume), while H0040 ranks #2 of 12 (91th percentile; notably above typical state volume), underscoring the provider’s outsized share of certain programmatic behavioral health services in West Virginia.
Telehealth is a notable operational channel for this provider: Q3014 has 124.6K claims and $2.9M revenue (3.8% of Medicaid revenue) and ranks #1 of 80 in-state (100th percentile; extreme outlier). The combination of very high claim volume for originating site fees and large per‑15‑minute counseling counts suggests the organization functions as a frequent telehealth access point for Medicaid members.
Intake and diagnostic capacity appears robust: H0031 (mental health assessment by non‑physician) shows 16.6K claims and $2.6M revenue (3.4%) with a #3 of 119 state rank (98th percentile; extreme outlier), and 90792 psychiatric evaluation has 11.6K claims and $1.4M revenue (1.9%) ranked #1 of 98 (100th percentile; extreme outlier). These volumes indicate high throughput of assessments and evaluations, supporting the large counseling and per‑diem program volumes.
The provider also generates very high volumes of standard outpatient evaluation-and-management visits alongside behavioral services: 99212 has 53.1K claims ($1.8M, 2.3%) and ranks #2 of 536 in-state (100th percentile; extreme outlier), while 99213 has 50.1K claims ($2.7M, 3.5%) and ranks #32 of 1273 (98th percentile; notably above typical state volume). This pattern suggests integrated, frequent face‑to‑face or telehealth E/M encounters embedded within the behavioral health delivery model.
PRESTERA is an established operator with lengthy tenure in the registry: NPI enumerated 2005-09-20 (~21 years ago). Taken together with the large Medicaid footprint, dominant state ranks on multiple codes, and concentrated programmatic revenue, the data depict a long-standing community behavioral health agency with deep penetration in West Virginia’s Medicaid behavioral health delivery system.
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.
35 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| H2036 | Alcohol and/or other drug treatment program, per diem | 123,140 | $180 | $22.5M |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 177,540 | $90 | $15.3M |
| H0040 | Assertive community treatment program, per diem | 186,610 | $80 | $15.1M |
| H0036 | Community psychiatric supportive treatment, face-to-face, per 15 minutes | 15,590 | $280 | $4.3M |
| Q3014 | Telehealth originating site facility fee | 124,570 | $20 | $2.9M |
| 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… | 50,110 | $50 | $2.7M |
| H0031 | Mental health assessment, by non-physician | 16,570 | $150 | $2.6M |
| S0281 | Medical home program, comprehensive care coordination and planning, maintenance of plan | 36,220 | $60 | $2.2M |
| 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,… | 53,090 | $30 | $1.8M |
| 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… | 11,590 | $120 | $1.4M |
Showing 1–10 of 35
How this provider's Medicaid billing volume and revenue compare to other West Virginia providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. West Virginia median
35 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| H2036 | Alcohol and/or other drug treatment program, per diem | 2 | 40 | 29,190 | $210 | $7.8M |
| H0040 | Assertive community treatment program, per diem | 2 | 10 | 71,630 | $80 | $6.8M |
| H0036 | Community psychiatric supportive treatment, face-to-face, per 15 minutes | 2 | 20 | 2,650 | $460 | $2.9M |
| H0038 | Self‑help/peer services, per 15 minutes | 33 | 60 | 3,310 | $110 | $1.6M |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 1 | 170 | 8,500 | $80 | $1.5M |
| T1040 | Medicaid certified community behavioral health clinic services, per diem | 4 | 10 | 3,100 | $270 | $790.4K |
| 80307 | The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date. | 19 | 110 | 2,080 | $50 | $537.1K |
| T1016 | Case management, each 15 minutes | 89 | 100 | 2,790 | $90 | $496.2K |
| S0281 | Medical home program, comprehensive care coordination and planning, maintenance of plan | 3 | 30 | 1,020 | $50 | $438.2K |
| H0031 | Mental health assessment, by non-physician | 3 | 120 | 620 | $160 | $312.6K |
Showing 1–10 of 35
Other providers in the same ZIP code as Prestera Center For Mental Health Services Inc, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Panhandle Support Services, Inc. | WV | In Home Supportive Care Agency | $0 | $29.1M |
| Village Caregiving, LLC | WV | In Home Supportive Care Agency | $0 | $16.7M |
| Valley Health Systems, Inc. | WV | Federally Qualified Health Center (FQHC) | $0 | $2.7M |
| Womencare Inc | WV | Federally Qualified Health Center (FQHC) | $0 | $2.3M |
| S. Glenn Bailey O.d., Inc. | WV | Optometrist | $0 | $2.1M |
| Amy Vaughan | WV | Dermatology Physician | $312.5K | $0 |
| Cynthia Pinson | WV | Family Medicine Physician | $206.4K | $0 |
| Walgreen Co | WV | Pharmacy | $99.1K | $0 |
| Suzanne Celdran | WV | Family Nurse Practitioner | $78.2K | $0 |
| David Humphreys | WV | Psychiatry Physician | $69.6K | $0 |
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