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

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

Professional Care Services Of West Tn, Inc. (NPI 1457351215)

Field	Value
Entity Type	Organization
Organization	Professional Care Services Of West Tn, Inc.
Address	1997 Highway 51 S
City	Covington
State	TN
ZIP	38019
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	July 22, 2005

Payer Source	Total Paid
Medicaid	$33.2M
Medicare	$0

Key Findings

PROFESSIONAL CARE SERVICES OF WEST TN, INC. is effectively a Medicaid-focused provider: it has no Medicare billing on file and reports $33.2M in lifetime Medicaid revenue, making Medicaid the sole material payer represented in this dataset. The absence of Medicare activity means analyses of national Medicare-facing competitiveness are not applicable for this entity.

Revenue is highly concentrated in a small set of programmatic codes: the precomputed top three Medicaid codes account for 85.1% of the provider’s total Medicaid revenue, with S0280 contributing $16.5M (49.8%), H0043 contributing $9.9M (29.8%), and 99213 contributing $1.8M (5.5%). This concentration indicates the business is driven primarily by a few programmatic and outpatient visit codes rather than a broad mix of fee-for-service items.

The code mix points to an operational model centered on care coordination and housing support plus high-volume outpatient encounters: S0280 (Medical home program, comprehensive care coordination and planning, initial plan) has 101.4K claims and $16.5M revenue, and H0043 (Supported housing, per diem) has 117.9K claims and $9.9M revenue. Together these programmatic codes suggest the provider operates as a community mental health/medical-home-style organization that couples care coordination with supported housing services.

Competitive standing for the programmatic codes is modest within state peers: S0280 ranks #12 of 40 in-state (72th percentile; typical, unremarkable volume for this code) and H0043 ranks #7 of 20 in-state (68th percentile; typical, unremarkable volume for this code). These rankings indicate the provider is a routine participant statewide in these programmatic lines rather than a dominant outlier.

The provider shows above-typical outpatient and psychotherapy activity relative to broader in-state peers: 99213 ranks #89 of 4050 (98th percentile; notably above typical state volume) and psychotherapy codes such as 90834 ($1.4M, ranks #20 of 360, 95th percentile) and 90832 ($760.3K, ranks #22 of 300, 93th percentile) are also high in-state. This pattern indicates a substantial volume of routine office visits and psychotherapy delivery on top of the programmatic services.

Two coordinated-care codes report large claim counts but $0 paid revenue: G9010 has 70.1K claims and G9006 has 41.9K claims while both show $0 revenue. Both codes rank moderately high in-state (G9010 #10 of 37, 75th percentile; G9006 #6 of 27, 81th percentile), which suggests extensive reporting of coordinated care/home monitoring activities in administrative datasets without direct paid amounts captured here.

Beyond the top two programmatic codes, the provider offers a range of ancillary psychiatric services—90791 ($671.2K), 90792 ($351.9K), 90837 ($340.5K), and H0037 ($322.2K)—that together represent supplemental clinical capacity. These services reinforce the interpretation that the organization combines care coordination and housing supports with active clinical evaluation and psychotherapy services.

The provider’s NPI has been enumerated since 2005-07-22 (~21 years ago), indicating a long tenure in the market; coupled with high cumulative claim volumes on core programmatic codes, this suggests an established community mental health operation rather than a recent entrant or sporadic biller.

Medicaid: Complete Services Breakdown

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

31 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S0280	Medical home program, comprehensive care coordination and planning, initial plan	101,420	$160	$16.5M
H0043	Supported housing, per diem	117,880	$80	$9.9M
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…	46,020	$40	$1.8M
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…	22,570	$60	$1.4M
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…	17,280	$40	$760.3K
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…	14,700	$50	$735K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	8,190	$80	$671.2K
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…	5,030	$70	$351.9K
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…	4,150	$80	$340.5K
H0037	Community psychiatric supportive treatment program, per diem	4,600	$70	$322.2K

Showing 1–10 of 31

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Professional Care Services Of West Tn, Inc. — 2 of 23 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

31 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S0280	Medical home program, comprehensive care coordination and planning, initial plan	12	40	22,180	$140	$21.3M
H0037	Community psychiatric supportive treatment program, per diem	11	20	20,260	$150	$19.4M
H0043	Supported housing, per diem	7	20	69,350	$180	$18.6M
H0034	Medication training and support, per 15 minutes	6	20	610	$60	$421.5K
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…	20	360	350	$50	$414.4K
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…	52	440	530	$70	$282.3K
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…	22	300	480	$30	$221.2K
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…	223	3,760	610	$40	$202.3K
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…	89	4,050	620	$30	$183.9K
90847	A provider meets with the patient’s family with the patient present to counsel the family on the psychological issues affecting the patient and the family. The provider supplies psychotherapy to the…	38	110	450	$50	$182.5K

Showing 1–10 of 31

Related Providers

Other providers that share a Tax Identification Number (TIN) with Professional Care Services Of West Tn, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Samantha Person-aldridge	TN	Psychiatric/Mental Health Nurse Practitioner	$15.3K	$0
Vicky Valentine-phillips	AR	Clinical Social Worker	$13.4K	$0

Nearby Providers

Other providers in the same ZIP code as Professional Care Services Of West Tn, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Personal Care Services Midsouth, LLC	TN	In Home Supportive Care Agency	$0	$18M
Baptist Memorial Hospital-tipton	TN	General Acute Care Hospital	$0	$13.9M
Saint Francis Physician Network, LLC	TN	Family Medicine Physician	$0	$3.3M
Karen Martin	TN	Family Nurse Practitioner	$97.9K	$0
James Martin	TN	Family Medicine Physician	$85.7K	$0
Lusia Filetti	TN	Obstetrics & Gynecology Physician	$7.5K	$0

Professional Care Services Of West Tn, Inc. — Billing Profile & Reimbursement Data

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Professional Care Services Of West Tn, Inc. — 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