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.

Appalachianwellness Clinic Inc (NPI 1427563238)

Appalachianwellness Clinic Inc is a addiction medicine (family medicine) physician provider located in Beckley, West Virginia. This profile covers 0 Medicare and 9 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Appalachianwellness Clinic Inc
Address	425 Stanaford Rd
City	Beckley
State	WV
ZIP	25801
Taxonomy	Addiction Medicine (Family Medicine) Physician
NPI Enumerated	December 4, 2017

Payer Source	Total Paid
Medicaid	$1.4M
Medicare	$0

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

9 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
90833	In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the…	11,070	$50	$542.6K
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…	6,380	$60	$350.8K
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…	5,360	$50	$284K
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,…	5,480	$40	$202.7K
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…	170	$70	$11.2K
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…	140	$70	$9.3K
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	50	$20	$830
99205	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…	30	$10	$300
81025	The lab analyst performs the pregnancy test on a urine specimen using a methodology or kit that the analyst can read visually for a direct readout.	40	$10	$270

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

Appalachianwellness Clinic Inc — 1 of 9 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

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	290	1,270	1,240	$30	$245K
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…	808	1,030	890	$50	$221K
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	98	100	940	$20	$62.4K
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…	131	210	280	$40	$59.2K
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…	21	200	490	$30	$57.7K
90833	In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the…	1	40	230	$40	$55.9K
99205	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…	74	110	90	$90	$46.3K
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,…	49	540	320	$20	$43.2K
81025	The lab analyst performs the pregnancy test on a urine specimen using a methodology or kit that the analyst can read visually for a direct readout.	162	200	360	$20	$33.8K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Raleigh General Hospital LLC	WV	General Acute Care Hospital	$0	$36.4M
Community Health Systems, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$35M
Fmrs Health Systems Inc	WV	Community/Behavioral Health Agency	$0	$27M
Health Care Alliance, Inc.	WV	Emergency Medicine Physician	$0	$25M
Jan-care Ambulance Of Raleigh County Inc	WV	Land Ambulance	$1.9M	$20.8M
Appalachian Regional Healthcare, Inc	WV	General Acute Care Hospital	$0	$18.3M
Raleigh County Commission On Aging, Inc.	WV	Home Health Agency	$0	$16.7M
Mountain State Home Health Care Inc	WV	Nursing Care Agency	$0	$16.5M
Family Options Providers, LLC.	WV	Community/Behavioral Health Agency	$0	$16.1M
Raleigh County Commission On Aging, Inc.	WV	Home Health Agency	$0	$13.8M

Appalachianwellness Clinic Inc — Billing Profile & Reimbursement Data

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Appalachianwellness Clinic Inc — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References