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.

State Of Missouri (NPI 1437781499)

Field	Value
Entity Type	Organization
Organization	State Of Missouri
Address	3418 Knipp Dr
City	Jefferson City
State	MO
ZIP	65109
Taxonomy	Rehabilitation Counselor
NPI Enumerated	February 7, 2020

Payer Source	Total Paid
Medicaid	$160.2M
Medicare	$0

Key Findings

This entity reports no Medicare billing on file and is effectively a Medicaid-only billing entity, with Total Medicaid revenue of $160.2M. The absence of Medicare activity means payer exposure and revenue risk are concentrated in Medicaid programs rather than split across payers.

Revenue is highly concentrated: the precomputed top three Medicaid codes account for 100.0% of this provider's total Medicaid revenue, with H0018 alone representing $134.5M (84.0% of Medicaid revenue). This concentration indicates that a single service line — short-term residential behavioral health — dominates the provider’s financial footprint.

The code mix and unit values point to a residential behavioral-health operating model: H0018 (short-term residential, per diem) has 45.2K claims at a $2978 avg paid/claim and generates $134.5M in revenue, while H2016 (comprehensive community support services, per diem) has far higher claim volume (202.8K claims) but a much lower $126 avg paid/claim and $25.6M revenue. These figures are consistent with a program that combines relatively few high-dollar residential days with a larger volume of low-unit community-support days.

Competitive standing within the state is strong for the provider’s main residential code: H0018 ranks #1 of 4 providers in-state (100th percentile; labeled “typical, unremarkable volume” in the data). For H2016 the provider ranks #1 of 1 providers in-state (0th percentile; no state peer volume comparison available), which limits direct peer benchmarking but indicates it is the sole reported biller for that code in the dataset.

Telehealth facility-fee activity is a notable statistical outlier relative to peers: Q3014 (telehealth originating site facility fee) shows 9.5K claims at a $15 avg paid/claim for $142.2K in revenue and ranks #2 of 103 providers in-state (99th percentile; “extreme outlier, far above typical state volume for this code”). Although Q3014 contributes only 0.1% of Medicaid dollars, the unusually high count and percentile suggest an operational emphasis on originating-site telehealth billing that is atypical among in-state providers.

Operational scale is reflected in contrasting claim and unit-price dynamics: H2016’s 202.8K claims versus H0018’s 45.2K claims, combined with the $126 vs $2978 avg paid/claim, imply a high-frequency, low-unit-value community-support workload paired with lower-frequency, high-unit-value residential stays. Analysts should interpret utilization metrics alongside unit prices to understand capacity and resource allocation between community and residential services.

The provider’s NPI was enumerated on 2020-02-07 (reported as ~6 years ago), meaning this Medicaid-dominant billing profile and $160.2M revenue base have been established within a relatively recent enrollment period. That timing may reflect growth tied to state program activity or contract awards post-enumeration.

Because nearly all Medicaid revenue is concentrated in behavioral-health related per-diem codes (H0018 at 84.0% and H2016 at 15.9%), the provider’s financial performance and payer negotiations are likely sensitive to reimbursement changes, policy updates, or utilization management for those specific codes. Payer and provider analysts should prioritize monitoring rate changes, prior authorization trends, and programmatic shifts affecting H0018 and H2016 for impact assessment.

Medicaid: Complete Services Breakdown

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

3 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	45,180	$2,980	$134.5M
H2016	Comprehensive community support services, per diem	202,810	$130	$25.6M
Q3014	Telehealth originating site facility fee	9,480	$20	$142.2K

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

State Of Missouri — 2 of 3 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

3 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	1	10	950	$2,880	$34.1M
H2016	Comprehensive community support services, per diem	1	10	202,810	$130	$25.5M
Q3014	Telehealth originating site facility fee	2	100	110	$10	$12.1K

Nearby Providers

Other providers in the same ZIP code as State Of Missouri, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Help At Home, LLC	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$97M
Ssm Regional Health Services	MO	General Acute Care Hospital	$0	$20.8M
Rehab Specialty Medical, Inc.	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$19.7M
Day Solutions, Inc	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$14M
Skillset LLC	MO	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$11.6M
Independent Living Resource Center, Inc.	MO	Home Health Agency	$0	$8.3M
Tiffany Burns	MO	Student in an Organized Health Care Education/Training Program	$0	$7.7M
County Of Cole	MO	Land Ambulance	$809.3K	$5.2M
Community Hospices Of America, LLC	MO	Community Based Hospice Care Agency	$0	$4M
Stephen Sides	MO	Rheumatology Physician	$2.9M	$0

State Of Missouri — Billing Profile & Reimbursement Data

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State Of Missouri — 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