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.

Bjc Behavioral Health (NPI 1427590371)

Field	Value
Entity Type	Organization
Organization	Bjc Behavioral Health
Address	3309 S Kingshighway Blvd
City	Saint Louis
State	MO
ZIP	63139
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	November 9, 2016

Payer Source	Total Paid
Medicaid	$155.6M
Medicare	$0

Key Findings

BJC BEHAVIORAL HEALTH is effectively a single‑payer provider: there is no Medicare billing on file and all reported federal fee‑for‑service revenue is from Medicaid, totaling $155.6M. This concentration makes Medicaid policy and contract changes the primary revenue driver for the organization.

Revenue is extremely concentrated in a single service line: the precomputed top 3 Medicaid codes by revenue account for 100.0% of this provider's total Medicaid revenue, and T1040 alone generates $155.2M (99.7% of the provider's Medicaid revenue). That concentration indicates the organization’s financial performance is overwhelmingly dependent on a single per‑diem CCBHC reimbursement stream.

The code mix and dollar distribution point to an operational model built around Medicaid certified community behavioral health clinic services: T1040 (Medicaid certified community behavioral health clinic services, per diem) has 546.4K claims with an average paid/claim of $284, consistent with a per‑diem, clinic‑level billing model rather than fee‑for‑service outpatient visits. Other E/M and psychotherapy codes are present but contribute only a tiny share of revenue, suggesting patient contact may be captured under the T1040 per‑diem rather than paid separately.

Despite T1040 dominance in dollars, the provider is a mid‑tier in statewide per‑diem volume: T1040 ranks #8 of 31 providers in‑state (77th percentile; typical, unremarkable volume for this code). At the same time, several H‑series program codes show mid‑to‑upper percentile ranks (for example, H0036 ranks #6 of 23, 77th percentile; H2010 ranks #7 of 23, 73rd percentile), indicating a broad programmatic footprint across community behavioral health service types even if those codes do not drive separate Medicaid dollars.

One notable statistical outlier in the fee‑for‑service mix is 99214: the provider reports 68.1K claims for 99214 with $5 avg paid/claim and $340.5K revenue, and this code ranks #15 of 3166 providers in‑state (100th percentile; extreme outlier, far above typical state volume for this code). That unusually high 99214 claim volume relative to peers merits attention during utilization review and contract negotiations because it departs sharply from typical E/M patterns in the state.

Multiple programmatic H‑codes and other behavioral health activity appear with very large claim counts but $0 avg paid/claim (examples: H0036 446.1K claims, H0037 68.7K claims, H2017 40.5K claims, H0032 13.3K claims). The coexistence of high claim volumes with zero reported Medicaid paid amounts suggests many services are likely bundled into per‑diem or capitated payments (consistent with the dominant T1040 per‑diem) rather than billed as separately reimbursed line items.

Psychotherapy codes are billed but contribute negligible revenue compared with the per‑diem: 90837 reports 1.2K claims and $23.4K revenue, and 90834 reports 1.7K claims and $20K revenue; both are described as typical, unremarkable volume for their peer groups. This pattern supports the interpretation that direct psychotherapy sessions are part of a broader clinic day‑rate structure rather than the primary revenue source.

The provider has an established enrollment history (NPI enumerated 2016-11-09, ~10 years ago), and over that period it has built a sizable Medicaid revenue base ($155.6M). That tenure combined with large per‑diem Medicaid receipts indicates a mature community/behavioral health agency operation concentrated on Medicaid CCBHC reimbursements.

Medicaid: Complete Services Breakdown

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

24 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1040	Medicaid certified community behavioral health clinic services, per diem	546,440	$280	$155.2M
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…	68,110	$10	$340.5K
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…	1,230	$20	$23.4K
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…	1,660	$10	$20K
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…	1,440	$10	$8.6K
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…	1,340	$10	$6.7K
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…	2,780	$1	$5.6K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	360	$10	$1.8K
99215	The provider sees an established 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…	20	$100	$1.6K
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…	40	$0	$0

Showing 1–10 of 24

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

Bjc Behavioral Health — 1 of 9 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

24 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1040	Medicaid certified community behavioral health clinic services, per diem	8	30	198,100	$260	$125.7M
H0037	Community psychiatric supportive treatment program, per diem	7	20	56,420	$120	$11.7M
H0036	Community psychiatric supportive treatment, face-to-face, per 15 minutes	6	20	214,040	$20	$10.8M
H2017	Psychosocial rehabilitation services, per 15 minutes	12	20	40,460	$20	$2M
H2012	Behavioral health day treatment, per hour	12	10	33,050	$30	$1.9M
H0004	Behavioral health counseling and therapy, per 15 minutes	12	40	3,680	$30	$978K
H0005	Alcohol and/or drug services; group counseling by a clinician	14	20	16,420	$20	$858.5K
H0040	Assertive community treatment program, per diem	5	10	20,740	$10	$572.6K
H0025	Behavioral health prevention education service (delivery of services with target population to affect knowledge, attitude and/or behavior)	17	30	6,100	$10	$339.7K
H2010	Comprehensive medication services, per 15 minutes	7	20	8,760	$10	$336.6K

Showing 1–10 of 24

Related Providers

Other providers that share a Tax Identification Number (TIN) with Bjc Behavioral Health, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Omar Butt	MO	Medical Oncology Physician	$1.2M	$0
Eileen Wu-evans	MO	Psychiatry Physician	$20.8K	$0

Nearby Providers

Other providers in the same ZIP code as Bjc Behavioral Health, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
City Of St Louis	MO	Ambulance	$843.1K	$28.1M
Magdala Foundation	MO	Intellectual Disabilities Intermediate Care Facility	$0	$7.5M
David Prelutsky	MO	Internal Medicine Physician	$148.1K	$770
Amy Stoppelman	MO	Clinical Social Worker	$68.8K	$2.1K
Michael Finn	MO	Anesthesiology Physician	$45.6K	$0
Kimberly Autry	MO	Adult Health Nurse Practitioner	$27.8K	$0
Robert Baird	MO	Internal Medicine Physician	$9.5K	$0

Bjc Behavioral Health — Billing Profile & Reimbursement Data

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Bjc Behavioral Health — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References