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

Why is the Medicaid comparison limited to Kentucky 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. Kentucky (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.

Northern Kentucky Mental Health Mental Retardation Regional Board (NPI 1437351376)

Field	Value
Entity Type	Organization
Organization	Northern Kentucky Mental Health Mental Retardation Regional Board
Address	503 Farrell Drive
City	Covington
State	KY
ZIP	41011
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	June 4, 2007

Payer Source	Total Paid
Medicaid	$68.3M
Medicare	$0

Key Findings

This provider is effectively single-payer Medicaid: there is no Medicare billing on file while Medicaid revenue totals $68.3M. That concentration means operations, contracting, and financial performance are likely aligned with state Medicaid and waiver program rules rather than Medicare payment structures.

Revenue is highly concentrated in a small number of Medicaid codes: the top three codes (97535, T1019, T2022) account for 68.8% of the provider's total Medicaid revenue. Specifically, 97535 accounted for $20.8M (30.4%), T1019 for $14.9M (21.8%), and T2022 for $11.3M (16.6%), creating material exposure if reimbursement or utilization patterns for those services change.

The code mix points to a community-based, services-heavy model focused on personal care, case management, and therapeutic activities: 97535 (223.2K claims, $93 avg paid/claim) and T1019 (133.2K claims, $112 avg paid/claim) represent high-volume, time- and activity-based interventions, while T2022 (40.8K claims, $277 avg paid/claim) reflects ongoing case management. Complementary codes such as T2016 (residential habilitation) and T2021 (day habilitation) indicate the organization provides both residential and day habilitation services consistent with waiver and long-term services and supports.

Competitive standing across the state is mixed but strong in several core services: 97535 ranks #10 of 305 providers in-state (97th percentile) and T2022 ranks #7 of 81 providers (93th percentile), signaling a strong statewide position for therapeutic activity and case-management services. By contrast, T1019 ranks #12 of 51 providers (78th percentile), which is a solid but less dominant placement for personal care services, suggesting the provider is a major player for some lines and a more modest participant for others.

There are notable statistical outliers in the provider's Medicaid profile: T1005 (respite care) is ranked #4 of 81 providers in-state (96th percentile) and is described as "notably above typical state volume," generating $3.3M (4.9% of Medicaid revenue). Although T1005 contributes a smaller share of total revenue, its unusually high state ranking indicates a particular emphasis or specialty in respite services relative to peers.

Operational indicators show a high-volume, labor-intensive service model: several top codes are billed by the 15-minute unit and have very large claim counts (e.g., 223.2K claims for 97535 and 133.2K claims for T1019). Combined with modest average paid-per-claim amounts for those codes, this suggests the business model depends on scale and workforce capacity rather than large per-encounter revenues.

The provider's time in the system—NPI enumerated 2007-06-04 (~19 years ago)—indicates an established presence in the state Medicaid market and likely long-standing relationships with state agencies and managed care plans. That tenure supports continuity for complex waiver and habilitation programs and may underpin the sizable volumes reported across multiple service lines.

Given the concentration in a few waiver- and habilitation-related codes, the provider has both opportunity and vulnerability: its strong statewide ranks for core services position it to be a key partner for Medicaid-managed programs, but the fact that top codes drive the majority of revenue (68.8% from the top three) means reimbursement rate changes or program policy shifts for those codes would have outsized financial impact.

Medicaid: Complete Services Breakdown

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
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	223,240	$90	$20.8M
T1019	Personal care services, per 15 minutes, 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…	133,200	$110	$14.9M
T2022	Case management, per month	40,810	$280	$11.3M
T2016	Habilitation, residential, waiver; per diem	65,320	$160	$10.5M
T1005	Respite care services, up to 15 minutes	51,790	$60	$3.3M
T2040	Financial management, self-directed, waiver; per 15 minutes	25,160	$100	$2.5M
S5108	Home care training to home care client, per 15 minutes	28,140	$80	$2.2M
T2021	Day habilitation, waiver; per 15 minutes	30,070	$60	$1.8M
S5125	Attendant care services; per 15 minutes	13,530	$70	$974.4K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Northern Kentucky Mental Health Mental Retardation Regional Board — 2 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5108	Home care training to home care client, per 15 minutes	61	100	43,820	$140	$16.6M
T2016	Habilitation, residential, waiver; per diem	47	150	42,680	$190	$11.3M
T1019	Personal care services, per 15 minutes, 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…	12	50	13,600	$140	$11.1M
T2022	Case management, per month	7	80	7,120	$290	$4.1M
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	10	310	830	$120	$3.7M
T2040	Financial management, self-directed, waiver; per 15 minutes	14	40	14,910	$160	$3.5M
S5125	Attendant care services; per 15 minutes	5	10	23,220	$100	$2.3M
T2021	Day habilitation, waiver; per 15 minutes	43	150	16,130	$70	$1.7M
T1005	Respite care services, up to 15 minutes	4	80	2,880	$70	$799.2K

Nearby Providers

Other providers in the same ZIP code as Northern Kentucky Mental Health Mental Retardation Regional Board, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Gravity Diagnostics, LLC	KY	Clinical Medical Laboratory	$1.6M	$116.2M
Northern Kentucky Mental Health Mental Retardation Regional Board	KY	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$53.4M
Nky Med, LLC	KY	Methadone Clinic	$298.9K	$24.4M
The Point Arc Of Northern Kentucky	KY	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$21.6M
Children's Home Of Northern Kentucky	KY	Community/Behavioral Health Agency	$0	$7.9M
Summit Medical Group, Inc	KY	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$4.2M
Familycare Counseling Solutions LLC	KY	Professional Counselor	$0	$3.2M
Caretenders Vs Of Central Ky, LLC	KY	Home Health Agency	$0	$2.9M
City Of Covington	KY	Ambulance	$355.7K	$1.6M
William Metzger	KY	Optometrist	$194.5K	$43K

Northern Kentucky Mental Health Mental Retardation Regional Board — Billing Profile & Reimbursement Data

Sign up for Northern Kentucky Mental Health Mental Retardation Regional Board — Billing Profile & Reimbursement Data policy alerts

Northern Kentucky Mental Health Mental Retardation Regional Board — Billing Profile & Reimbursement Data

Sign up for Northern Kentucky Mental Health Mental Retardation Regional Board — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References