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NPI 1437213865 · Portland, OR · Substance Abuse Rehabilitation Facility
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Coda, Inc. is a substance abuse rehabilitation facility provider located in Portland, Oregon. This profile covers 5 Medicare and 40 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 | Coda, Inc. |
| Address | 1027 E Burnside St |
| City | Portland |
| State | OR |
| ZIP | 97214 |
| Taxonomy | Substance Abuse Rehabilitation Facility |
| NPI Enumerated | December 20, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $81M |
| Medicare | $442.9K |
CODA, INC. is effectively a Medicaid-first operator: reported Total Medicaid revenue is $81M versus Total Medicare revenue of $442.9K, indicating Medicaid is the dominant payer by several orders of magnitude and the organization functions largely within state Medicaid programs. The provider has been enumerated since 2006-12-20 (~20 years ago), signaling an established presence in the market and long-tenured participation in payer networks.
Medicare revenue is highly concentrated: the precomputed top 3 Medicare codes account for 98.0% of Medicare revenue, with G2067 alone representing $400.6K (90.5% of this provider's total Medicare revenue). This concentration shows the Medicare footprint is almost entirely tied to OTP-specific weekly bundles and a very small set of OTP services, making Medicare exposure narrow in service mix.
Medicaid revenue is also concentrated but across service types: the precomputed top 3 Medicaid codes account for 53.9% of Medicaid revenue, with H0019 (34.5% of Medicaid revenue), H0033 (10.7%), and H0020 (8.6%) driving the top share. That mix indicates revenue is split between long-term residential per diems (H0019) and very high-volume medication administration/direct observation lines (H0033, H0020), reflecting a combined residential and opioid-treatment program operating model.
The provider’s billing mix and high-volume codes indicate an integrated addiction-treatment platform: dominant codes include G2067 (OTP weekly bundle), H0019 (long-term residential per diem), H0033 (oral medication administration, direct observation), H0005 and H0004 (group and individual counseling), and H0048 (drug testing). This pattern—medication administration, supervised dosing, residential stays, and extensive counseling/testing—is consistent with a substance abuse rehabilitation facility offering both medication-assisted treatment and long-term residential services.
Competitive standing differs sharply between payers: on Medicare G2067 ranks #115 of 830 (86th percentile; typical, unremarkable volume), so the provider is a modest national participant on Medicare OTP billing rather than a dominant national player. By contrast, the provider is a major statewide actor on multiple Medicaid lines—H0033 ranks #1 of 22 in-state (100th percentile; extreme outlier, far above typical state volume) and H0048 ranks #1 of 162 in-state (100th percentile; extreme outlier), while H0019 ranks #3 of 31 in-state (93th percentile; notably above typical state volume)—together these placements indicate substantial in-state market share for medication administration and testing services.
Claim volumes corroborate operational scale in Medicaid services: H0033 shows 856K claims and H0020 shows 863.1K claims, while H0005 reports 143.2K claims and H0019 reports 116.8K claims. These very large claim counts for medication administration, counseling, and residential per diems explain the high Medicaid revenue total and underline significant treatment throughput within state programs.
The provider shows multiple statistical outlier designations in-state for Medicaid lines, which signals both market dominance and concentration risk: several codes are labeled extreme outlier or 100th percentile (for example, H0033, H0048, J0574, J0572, T1502, T1007, H0001 and others are 100th-percentile or extreme outliers), while core counseling and residential codes such as H0005 and H0004 are also extreme outliers. This combination suggests strong specialization in specific service types (medication administration, drug testing, and counseling/residential care) but also exposure if state policy, authorizations, or reimbursement for these high-volume codes change.
Given its ~20-year tenure, concentrated Medicare mix (98.0% of Medicare revenue tied to top 3 codes), and dominant, high-volume Medicaid footprint (top 3 Medicaid codes = 53.9% of Medicaid revenue), CODA, INC. operates as a long-established, Medicaid-centric substance abuse rehabilitation provider with deep operational focus on OTP services and long-term residential care. Analysts evaluating network adequacy, utilization management, or reimbursement policy impacts should treat Medicaid lines (especially H0033, H0019, H0020 and the numerous 100th-percentile codes) as the primary drivers of financial and operational risk and opportunity for this entity.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| G2067 | Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed… | 1,640 | $250 | $400.6K |
| G2172 | All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project | 60 | $330 | $19.5K |
| G2078 | Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure | 380 | $40 | $13.7K |
| G2077 | Periodic assessment; assessing periodically by an otp practitioner and includes a review of moud dosing, treatment response, other substance use disorder treatment needs, responses and… | 60 | $120 | $6.6K |
| G2076 | Intake activities, including initial medical examination that is conducted by an appropriately licensed practitioner and preparation of a care plan, which may be informed by administration of a… | 20 | $130 | $2.1K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 CPT/HCPCS codes.
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.
40 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| H0019 | Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem | 116,840 | $240 | $27.6M |
| H0033 | Oral medication administration, direct observation | 856,010 | $10 | $8.6M |
| H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | 863,130 | $10 | $6.9M |
| H0005 | Alcohol and/or drug services; group counseling by a clinician | 143,200 | $50 | $6.6M |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 104,510 | $60 | $5.7M |
| H0048 | Alcohol and/or other drug testing: collection and handling only, specimens other than blood | 220,420 | $20 | $5.1M |
| J0574 | Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine | 232,320 | $10 | $3.3M |
| T1020 | Personal care services, per diem, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify… | 830 | $3,840 | $3.2M |
| H0010 | Alcohol and/or drug services; sub‑acute detoxification (residential addiction program inpatient) | 2,520 | $1,000 | $2.5M |
| 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… | 12,380 | $120 | $1.5M |
Showing 1–10 of 40
How this provider's Medicaid billing volume and revenue compare to other Oregon providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Oregon median
40 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| H0010 | Alcohol and/or drug services; sub‑acute detoxification (residential addiction program inpatient) | 9 | 10 | 7,740 | $1,030 | $9M |
| H0019 | Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem | 3 | 30 | 2,560 | $400 | $8.9M |
| T1020 | Personal care services, per diem, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify… | 28 | 40 | 1,330 | $1,170 | $6.4M |
| H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | 4 | 30 | 86,800 | $10 | $2.4M |
| H0005 | Alcohol and/or drug services; group counseling by a clinician | 6 | 180 | 3,250 | $40 | $783.8K |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 3 | 270 | 1,660 | $90 | $681K |
| H0033 | Oral medication administration, direct observation | 1 | 20 | 4,620 | $10 | $521.2K |
| J0574 | Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine | 1 | 10 | 9,110 | $10 | $454.8K |
| H0038 | Self‑help/peer services, per 15 minutes | 41 | 150 | 1,030 | $80 | $417.2K |
| H2014 | Skills training and development, per 15 minutes | 83 | 120 | 1,010 | $40 | $323.2K |
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Other providers in the same ZIP code as Coda, Inc., ranked by combined Medicare and Medicaid revenue.
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