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NPI 1487059531 · Baltimore, MD · Case Management Agency
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Concerted Care Group Baltimore, LLC is a case management agency provider located in Baltimore, Maryland. This profile covers 6 Medicare and 23 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Concerted Care Group Baltimore, LLC |
| Address | 428 E. 25th Street |
| City | Baltimore |
| State | MD |
| ZIP | 21218 |
| Taxonomy | Case Management Agency |
| NPI Enumerated | October 31, 2014 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $26.3M |
| Medicare | $446.5K |
This provider’s billing profile is heavily Medicaid‑weighted: total Medicaid revenue is $26.3M while total Medicare revenue is $446.5K, indicating Medicaid dominates the revenue mix and the organization operates primarily as a Medicaid‑facing service provider. The disparity in scale suggests the provider is effectively Medicaid‑centric rather than balanced across the two federal payers.
The code mix and top revenue drivers point to a focused opioid use disorder and medication‑assisted treatment operation: Medicare top codes include G2067, G2172, and G2077 (the dataset’s top three Medicare codes account for 91.6% of Medicare revenue) while Medicaid top codes include H0020, W1761, and H0004 (the dataset’s top three Medicaid codes account for 66.2% of Medicaid revenue). These codes describe methadone administration, bundled OTP services, counseling and therapy, and related SUD services consistent with the provider taxonomy of Case Management Agency.
Revenue concentration is acute on both payers: the provider’s top three Medicare codes represent 91.6% of its Medicare revenue, driven largely by G2067; on Medicaid the top three codes represent 66.2% of Medicaid revenue, led by H0020 ($10.2M, 39.1%) and W1761 ($4.4M, 17.0%). This concentration indicates that a small set of SUD/OTP services drives the majority of billed revenue across payers.
Medicare competitive standing is mixed: G2067 generates $338.6K and ranks #152 of 830 nationally (around the 82nd percentile) and is described as typical/unremarkable volume, while G2172 (118 claims, $39.1K) ranks #3 of 24 (about the 91st percentile) and G2077 (272 claims, $31.8K) ranks #13 of 352 (about the 97th percentile). In plain terms, the provider has a modest national footprint on the high‑revenue Medicare bundle G2067 but shows relatively strong national ranking on several specialized OTP assessment and demonstration codes.
On Medicaid the provider is a major in‑state participant for several SUD services: H0020 shows 138.2K claims and $10.2M revenue (39.1%) and ranks #11 of 108 in‑state (91st percentile), W1761 shows 37.7K claims and $4.4M revenue (17.0%) and ranks #1 of 110 in‑state (100th percentile, labeled an extreme outlier), and H0004 shows 41.3K claims and $2.6M revenue (10.1%) and ranks #10 of 382 (98th percentile). These rank/percentile positions and very large claim counts indicate the provider is a dominant state‑level operator for methadone administration, counseling, and at least one unusually large unspecified service (W1761).
There are notable state‑level outlier flags across multiple Medicaid codes: W1761 is listed as an extreme outlier (100th percentile), H0005 and H0001 are also described as extreme outliers in their in‑state ranks, and G2067 is ranked #1 of 49 in‑state for Medicaid despite accounting for only 0.3% of Medicaid revenue. Taken together, these descriptors point to areas where the provider’s in‑state activity is far above typical peers for certain services, likely reflecting very high claim volume on particular lines rather than broad diversification.
The provider has an established operational tenure—NPI enumerated on 2014-10-31 (~12 years)—which supports the interpretation that its concentrated Medicaid and OTP billing patterns represent sustained service lines rather than a short‑term spike. This longevity, combined with large Medicaid volumes, suggests the organization is an entrenched Medicaid provider for SUD/OTP care in its market.
Operational sensitivity is likely high because a majority of revenue is tied to a narrow set of SUD/OTP services and a few high‑volume Medicaid codes; changes in Medicaid coverage, payment policy, or program participation for H0020, W1761, or related OTP bundles could materially affect revenue. From a payer or network management perspective, this profile argues for monitoring utilization and reimbursement trends for those specific codes and for focusing credentialing and oversight on OTP‑related service delivery.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
6 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| G2067 | Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed… | 1,400 | $240 | $338.6K |
| G2172 | All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project | 120 | $330 | $39.1K |
| G2077 | Periodic assessment; assessing periodically by an otp practitioner and includes a review of moud dosing, treatment response, other substance use disorder treatment needs, responses and… | 270 | $120 | $31.8K |
| G2078 | Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure | 510 | $40 | $19.8K |
| G2074 | Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services… | 90 | $170 | $14.8K |
| G2076 | Intake activities, including initial medical examination that is conducted by an appropriately licensed practitioner and preparation of a care plan, which may be informed by administration of a… | 20 | $190 | $3K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 6 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
23 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | 138,200 | $70 | $10.2M |
| W1761 | N/A | 37,710 | $120 | $4.4M |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 41,310 | $60 | $2.6M |
| H0005 | Alcohol and/or drug services; group counseling by a clinician | 44,040 | $50 | $2M |
| J0574 | Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine | 125,100 | $10 | $1.8M |
| H0047 | Alcohol and/or other drug abuse services, not otherwise specified | 24,130 | $60 | $1.5M |
| 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… | 8,390 | $120 | $1M |
| H0001 | Alcohol and/or drug assessment | 4,300 | $170 | $730.8K |
| J0572 | Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine | 69,040 | $10 | $552.3K |
| 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… | 5,130 | $70 | $379.8K |
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How this provider's Medicaid billing volume and revenue compare to other Maryland providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Maryland median
23 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | 11 | 110 | 51,720 | $70 | $4.8M |
| J0574 | Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine | 3 | 40 | 9,260 | $20 | $756.2K |
| W1761 | N/A | 1 | 110 | 2,540 | $110 | $576.3K |
| H0047 | Alcohol and/or other drug abuse services, not otherwise specified | 3 | 50 | 2,370 | $70 | $484.7K |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 10 | 380 | 1,450 | $60 | $459K |
| 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… | 312 | 3,670 | 680 | $90 | $310K |
| J0572 | Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine | 4 | 30 | 11,420 | $10 | $307.4K |
| 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… | 529 | 3,280 | 610 | $80 | $296.1K |
| H0005 | Alcohol and/or drug services; group counseling by a clinician | 5 | 360 | 2,160 | $50 | $284.3K |
| H0016 | Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) | 8 | 80 | 240 | $240 | $141.1K |
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Other providers in the same ZIP code as Concerted Care Group Baltimore, LLC, ranked by combined Medicare and Medicaid revenue.
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