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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

Rio Grande Counseling & Guidance Services, PA (NPI 1477507069)

Rio Grande Counseling & Guidance Services, PA is a clinical social worker provider located in Albuquerque, New Mexico. This profile covers 0 Medicare and 9 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Rio Grande Counseling & Guidance Services, PA
Address	1010 Las Lomas Rd Ne
City	Albuquerque
State	NM
ZIP	87102
Taxonomy	Clinical Social Worker
NPI Enumerated	May 19, 2006

Payer Source	Total Paid
Medicaid	$9.9M
Medicare	$0

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
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…	55,040	$110	$6.1M
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	18,300	$180	$3.3M
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…	3,000	$80	$245.7K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	1,320	$120	$155.4K
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…	720	$90	$61.3K
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…	680	$60	$42.1K
99205	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…	70	$170	$11.1K
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…	120	$80	$9.6K
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…	60	$70	$4K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

Rio Grande Counseling & Guidance Services, PA — 1 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	12	50	4,480	$150	$2.7M
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…	524	930	910	$80	$521.6K
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…	540	960	1,010	$90	$490K
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…	1	920	860	$120	$361.9K
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…	62	380	400	$80	$213.5K
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…	230	290	470	$70	$161.5K
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…	117	180	300	$100	$134.2K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	42	340	80	$130	$69.4K
99205	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…	82	150	90	$170	$48.4K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Tricore Reference Laboratories	NM	Clinical Medical Laboratory	$0	$64.8M
Bright Horizons, Inc.	NM	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$46.9M
Lovelace Health System LLC	NM	General Acute Care Hospital	$0	$45.2M
Tricore Inc.	NM	Clinical Medical Laboratory	$7M	$35.8M
App Of New Mexico Ed PLLC	NM	Emergency Medicine Physician	$0	$42M
Duke City Recovery Toolbox LLC	NM	Community/Behavioral Health Agency	$108.4K	$28M
Metro Treatment Of New Mexico LP	NM	Methadone Clinic	$220.4K	$27.9M
Enchanted Care Solutions, LLC	NM	Home Health Agency	$0	$25.8M
Open Skies Healthcare	NM	Community/Behavioral Health Agency	$0	$23.8M
Krossroads Integrative Health And Recovery Solutions Inc	NM	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$16.7M

Rio Grande Counseling & Guidance Services, PA — Billing Profile & Reimbursement Data

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Rio Grande Counseling & Guidance Services, PA — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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