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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Healthways Inc (NPI 1366656225)

Field	Value
Entity Type	Organization
Organization	Healthways Inc
Address	501 Colliers Way
City	Weirton
State	WV
ZIP	26062
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	May 10, 2007

Payer Source	Total Paid
Medicaid	$40.8M
Medicare	$0

Key Findings

HEALTHWAYS INC shows no Medicare billing on file and is effectively a Medicaid-focused operation with $40.8M in reported Medicaid revenue. The provider’s NPI was enumerated on 2007-05-10 (approximately 19 years ago), indicating a long-tenured presence in the state Medicaid market but no Medicare footprint to diversify payer risk.

Revenue is highly concentrated in a very small set of Medicaid codes: the top three codes (S5125, T2021, T1005) together account for 90.8% of this provider’s Medicaid revenue. Individually those codes generate $28.3M (69.5%), $5.4M (13.3%), and $3.3M (8.0%) respectively, so most revenue depends on a handful of service lines.

The code mix (S5125 – attendant care services; T2021 – day habilitation, waiver; T1005 – respite care services) aligns with a community/behavioral health agency model focused on intensive personal attendant care, waiver-funded day habilitation programs, and respite support. High claim volumes and elevated average paid/claim on S5125 and T1005 suggest substantial in-home or one-to-one care capacity and program infrastructure to deliver frequently billed, time-based services.

S5125 is the dominant revenue engine with 16.3K claims and $28.3M revenue (69.5% of Medicaid revenue) but the provider ranks #20 of 43 in-state (55th percentile) for that code; this indicates the organization is a significant local provider of attendant care by absolute revenue but not a statewide market leader—its volume is characterized in the data as typical/ unremarkable rather than an outlier.

T2021 (day habilitation, waiver) contributes $5.4M (13.3% of Medicaid revenue) from 15.8K claims and ranks #16 of 57 in-state (73th percentile), which positions the provider above median for day habilitation activity; by contrast T1005 (respite) contributes $3.3M (8.0%) with 3K claims and ranks #15 of 29 (50th percentile), indicating average market participation for respite services.

Although the top three codes dominate, secondary codes show modest diversification into transportation, coordinated care fees, and case management: A0160 generates $1.1M (2.6% of revenue) and ranks #28 of 112 (76th percentile), G9002 generates $929.8K (2.3%) and ranks #43 of 123 (65th percentile), and T1016 generates $859K (2.1%) and ranks #29 of 96 (71th percentile). These lines represent smaller revenue pools but reflect operational capabilities in non-emergent transportation and care coordination tied to waiver services.

Operational scale implied by claim counts and average payment levels is notable: S5125 shows 16.3K claims at $1735 avg paid/claim, T2021 shows 15.8K claims at $345 avg paid/claim, and T1005 shows 3K claims at $1092 avg paid/claim, signaling large recurring service delivery volumes for time-based, hands-on supports. That claim-level intensity suggests the provider has established staffing and scheduling operations to sustain frequent, short-interval billing typical of attendant and habilitation services.

From a payer-mix and risk perspective, absence of Medicare revenue combined with concentration (90.8% in top three Medicaid codes) means the provider’s financial performance is highly sensitive to Medicaid policy, rate changes, and waiver program adjustments. Analysts should consider monitoring state waiver rules and reimbursement trends for attendant care and day habilitation when assessing the provider’s future revenue stability.

Medicaid: Complete Services Breakdown

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

10 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S5125	Attendant care services; per 15 minutes	16,340	$1,740	$28.3M
T2021	Day habilitation, waiver; per 15 minutes	15,780	$350	$5.4M
T1005	Respite care services, up to 15 minutes	2,980	$1,090	$3.3M
A0160	Non-emergency transportation: per mile - case worker or social worker	7,150	$150	$1.1M
G9002	Coordinated care fee, maintenance rate	4,630	$200	$929.8K
T1016	Case management, each 15 minutes	6,460	$130	$859K
A0120	Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems	3,170	$190	$611.4K
T1002	Rn services, up to 15 minutes	2,040	$70	$142.7K
T2024	Service assessment/plan of care development, waiver	2,080	$50	$107.9K
T1003	Lpn/lvn services, up to 15 minutes	1,340	$40	$46.9K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Healthways Inc — 0 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

10 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5125	Attendant care services; per 15 minutes	20	40	14,820	$750	$30.5M
T2021	Day habilitation, waiver; per 15 minutes	16	60	6,490	$120	$2.2M
T1005	Respite care services, up to 15 minutes	15	30	2,980	$250	$1.5M
G9002	Coordinated care fee, maintenance rate	43	120	2,950	$150	$901.9K
T1003	Lpn/lvn services, up to 15 minutes	22	30	2,070	$90	$522.7K
T1016	Case management, each 15 minutes	29	100	2,790	$90	$496.2K
A0160	Non-emergency transportation: per mile - case worker or social worker	28	110	2,030	$50	$278.8K
T1002	Rn services, up to 15 minutes	74	150	1,980	$40	$232.6K
A0120	Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems	18	50	1,390	$30	$183.1K
T2024	Service assessment/plan of care development, waiver	14	50	760	$50	$95.5K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Weirton Medical Center, Inc	WV	General Acute Care Hospital	$0	$27.7M
Change, Incorporated	WV	Federally Qualified Health Center (FQHC)	$0	$21.2M
Healthways Inc	WV	Community/Behavioral Health Agency	$0	$3M
First Steps Pediatrics & Adolescent Medicine PLLC	WV	Pediatrics Physician	$0	$2.5M
Hancock County Sheltered Workshop Inc.	WV	Community/Behavioral Health Agency	$0	$2.1M
Health Care Solutions At Home Inc.	WV	Durable Medical Equipment & Medical Supplies	$0	$1.8M
Family Connections	WV	Mental Health Counselor	$0	$818.8K
Tri State Medical	WV	Oxygen Equipment & Supplies (DME)	$0	$816K
Christopher Kolibash	WV	Clinical Cardiac Electrophysiology Physician	$425.8K	$48K
Maninder Bedi	WV	Cardiovascular Disease Physician	$416.1K	$53.8K

Healthways Inc — Billing Profile & Reimbursement Data

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Healthways 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