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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Capital Area Counseling Service, Inc (NPI 1467449157)

Field	Value
Entity Type	Organization
Organization	Capital Area Counseling Service, Inc
Address	2001 Eastgate
City	Pierre
State	SD
ZIP	57501
Taxonomy	Clinical Social Worker
NPI Enumerated	September 29, 2005

Payer Source	Total Paid
Medicaid	$7.6M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and reports $7.6M in lifetime Medicaid revenue, making its federal billing profile effectively single-payer (Medicaid) rather than split across Medicare and Medicaid. Analysts should treat Medicaid policy and rate changes as the primary external revenue risk for this entity given the absence of Medicare volume.

Revenue is highly concentrated: the top three Medicaid codes account for 97.7% of this provider's total Medicaid revenue. Those codes are H2021 (52.7K claims, $98 avg paid/claim, $5.2M revenue, 67.9% of Medicaid revenue), H2016 (26.5K claims, $76 avg paid/claim, $2M revenue, 26.4%), and 90863 (3.3K claims, $79 avg paid/claim, $258.4K revenue, 3.4%).

The code mix indicates a programmatic, community-based behavioral health operation rather than a traditional office-based psychotherapy practice. Heavy billing for H2021 (Community-based wrap-around services, per 15 minutes) and H2016 (Comprehensive community support services, per diem) signals ongoing, time-based community support and wrap-around programs as the core service lines, while 90863 (medication review after psychotherapy) points to some integrated pharmacological management within those programs.

Statewide competitive standing on the provider's top revenue drivers is modest to mid-tier: H2021 revenue ranks #4 of 11 in-state (70th percentile), H2016 ranks #7 of 11 (40th percentile), and 90863 ranks #8 of 12 (36th percentile). These ranks and percentiles describe typical, unremarkable in-state volumes for the primary codes rather than dominance in those program areas.

There are pockets of stronger relative positioning in specific secondary services. For example, T1012 (Alcohol and/or substance abuse services, skills development) accounts for $82.5K (1.1% of Medicaid revenue) on 2.3K claims and ranks #2 of 12 in-state (91th percentile), indicating a comparatively strong state-level presence in this specific service despite its small share of overall revenue.

Telehealth-originating site activity is notable relative to peers: Q3014 shows 667 claims at $11 avg paid/claim totaling $7.3K (0.1% of Medicaid revenue) and ranks #5 of 33 in-state (88th percentile). This suggests the provider uses telehealth as part of its delivery model more than many in-state peers, even though it contributes a small share of total revenue.

Traditional psychotherapy and office visit CPTs represent only a small fraction of revenue, reinforcing the programmatic focus. Codes such as 90832 ($8.9K, 240 claims), 90791 ($8.7K, 121 claims) and 99213 ($5.3K, 231 claims) are present but low-value relative to the H2021/H2016 backbone, implying the provider does not rely primarily on standard time-limited psychotherapy or evaluation billing.

The provider has a long-tenured NPI (enumerated 2005-09-29, ~21 years ago), indicating an established operational history in the market; however, the extreme concentration of Medicaid revenue in H2021 and H2016 (together comprising 94.3% by the individual shares given) means the business is operationally sensitive to reimbursement, program eligibility, or policy changes affecting those specific community support and wrap-around service codes.

Medicaid: Complete Services Breakdown

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2021	Community-based wrap-around services, per 15 minutes	52,740	$100	$5.2M
H2016	Comprehensive community support services, per diem	26,460	$80	$2M
90863	The provider prescribes and reviews medications for pharmacological management after psychotherapy services at the same encounter.	3,270	$80	$258.4K
T1012	Alcohol and/or substance abuse services, skills development	2,290	$40	$82.5K
H0004	Behavioral health counseling and therapy, per 15 minutes	500	$80	$37.5K
W0037	N/A	400	$60	$24.3K
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…	240	$40	$8.9K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	120	$70	$8.7K
Q3014	Telehealth originating site facility fee	670	$10	$7.3K
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…	230	$20	$5.3K

Showing 1–10 of 13

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Capital Area Counseling Service, Inc — 0 of 11 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

13 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2016	Comprehensive community support services, per diem	7	10	29,180	$80	$3.6M
H2021	Community-based wrap-around services, per 15 minutes	4	10	47,600	$90	$3.5M
90863	The provider prescribes and reviews medications for pharmacological management after psychotherapy services at the same encounter.	8	10	5,650	$90	$550.2K
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…	237	340	1,010	$100	$511K
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…	207	260	860	$80	$222.6K
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…	35	70	200	$80	$176.7K
H0005	Alcohol and/or drug services; group counseling by a clinician	19	20	520	$80	$128.2K
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…	21	30	330	$40	$104.9K
T1012	Alcohol and/or substance abuse services, skills development	2	10	1,030	$70	$81.9K
H0004	Behavioral health counseling and therapy, per 15 minutes	8	20	390	$90	$61.9K

Showing 1–10 of 13

Nearby Providers

Other providers in the same ZIP code as Capital Area Counseling Service, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Homecare Services Of South Dakota, Inc.	SD	Home Health Agency	$0	$20.1M
Resources For Human Development	SD	Case Management Agency	$0	$8.5M
Avera St Marys	SD	Multi-Specialty Clinic/Center	$0	$4.6M
Oahe, Inc.	SD	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$4.4M
Rising Hope Counseling, LLC	SD	Mental Health Counselor	$0	$4M
Central Dakota Eyecare, LLP	SD	Optometrist	$0	$1.8M
Avera St Marys	SD	General Acute Care Hospital	$0	$1.7M
Delta Dental Of South Dakota Foundation	SD	Dental Clinic/Center	$0	$1.2M
Delta Dental Of South Dakota Foundation	SD	Dental Clinic/Center	$0	$1M
Delta Dental Of South Dakota Foundation	SD	Dental Clinic/Center	$0	$594K

Capital Area Counseling Service, Inc — Billing Profile & Reimbursement Data

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Capital Area Counseling Service, 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

Nearby Providers

Frequently Asked Questions

References