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NPI 1487608485 · Worcester, MA · Addiction (Substance Use Disorder) Counselor
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Spectrum Health Systems, Inc is a addiction (substance use disorder) counselor provider located in Worcester, Massachusetts. This profile covers 5 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 | Spectrum Health Systems, Inc |
| Address | 585 Lincoln St |
| City | Worcester |
| State | MA |
| ZIP | 01605 |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| NPI Enumerated | May 22, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $187.4M |
| Medicare | $6M |
This entity is heavily Medicaid‑driven: reported Medicaid revenue is $187.4M compared with $6M in Medicare revenue, so Medicaid is the dominant payer by scale for the provider’s operations. The provider’s Medicaid receipts dwarf its Medicare receipts, indicating this organization functions primarily within the state Medicaid system rather than as a Medicare-focused practice.
Medicare billing is extremely concentrated: the top three Medicare codes account for 99.6% of the provider’s Medicare revenue, and G2067 alone represents $5.8M (96.7% of Medicare revenue). G2067 ranks #2 of 830 providers nationally (100th percentile; extreme outlier), signaling that Medicare activity is almost entirely driven by weekly methadone/OTP bundle services.
Medicaid revenue is also highly concentrated in a small set of services: the top three Medicaid codes account for 88.6% of Medicaid revenue, with H0020 at $94.7M (49.8%) and G2067 at $58M (30.5%) together representing the majority of Medicaid receipts. H0020 ranks #2 of 38 in-state (97th percentile; extreme outlier) and G2067 ranks #2 of 31 in-state (97th percentile; notably above typical), indicating the provider is a leading state-level performer for methadone administration and weekly OTP bundles.
The overall code mix points to an integrated opioid treatment program combined with residential and counseling services: high-volume codes are H0020 and G2067 (methadone administration and weekly OTP bundles), supported by per‑diem residential codes H0019, H0010, and H0011 and high counseling volume under H0004 and H0005. This pattern suggests on-site medication dispensing, structured counseling (individual and group), and a residential/detox continuum rather than a purely outpatient psychotherapy practice.
Competitive standing is strong at both scales where measured: nationally the provider is an outlier on G2067 (rank #2 of 830; 100th percentile; extreme outlier) and is notably above peers on G2074, while in-state it ranks at or near the top for H0020 and G2067 and is notably above typical volume for H0019 and H0004. These rank/percentile signals indicate the organization is a major operator of opioid treatment and methadone dispensing in its state and a nationally prominent biller for the primary OTP bundle on Medicare.
Beyond dispensing bundles, the provider reports meaningful residential and detox services: H0019 ($15.8M, 8.3% of Medicaid revenue), H0010 ($7.4M, 3.9%), and H0011 ($6.4M, 3.3%) together represent a substantial Medicaid revenue stream distinct from the weekly methadone bundles. The presence of these per‑diem residential codes alongside high-volume counseling codes (H0004 $2.3M and H0005 $1.4M) indicates a multi‑level service mix that includes longer-term residential treatment as well as outpatient counseling.
From a utilization and contracting perspective, payers should view this provider as a high‑volume OTP/residential vendor: large shares of revenue come from program-level bundles and drug administration codes (G2067, H0020), which are likely central to capacity and reimbursement negotiations. Given H0020 and G2067 together account for a substantial portion of Medicaid revenue and G2067 dominates Medicare billing, utilization management or program-level quality measures will capture most of this provider’s activity.
The provider’s NPI has been enumerated since 2006-05-22 (~20 years ago), consistent with the scale and established network position implied by the billing profile and rank positions. Longevity in the data aligns with the provider’s ability to accumulate high volumes across Medicaid OTP and residential code sets over time.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
5 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… | 22,400 | $260 | $5.8M |
| 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… | 600 | $210 | $126.8K |
| 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 | 1,290 | $40 | $48.8K |
| 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… | 110 | $120 | $12.5K |
| 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… | 50 | $200 | $9.7K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 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) | 6,764,010 | $10 | $94.7M |
| G2067 | Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed… | 414,280 | $140 | $58M |
| H0019 | Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem | 113,340 | $140 | $15.8M |
| H0010 | Alcohol and/or drug services; sub‑acute detoxification (residential addiction program inpatient) | 22,080 | $330 | $7.4M |
| H0011 | Alcohol and/or drug services; acute detoxification (hospital inpatient) per diem | 14,680 | $430 | $6.4M |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 41,160 | $60 | $2.3M |
| H0005 | Alcohol and/or drug services; group counseling by a clinician | 47,220 | $30 | $1.4M |
| 90791 | In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. | 7,970 | $120 | $972.1K |
| 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… | 8,870 | $110 | $931.1K |
| 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 | 19,510 | $30 | $624.4K |
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How this provider's Medicaid billing volume and revenue compare to other Massachusetts providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Massachusetts 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) | 2 | 40 | 26,400 | $10 | $9.7M |
| H0019 | Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem | 4 | 80 | 5,200 | $370 | $8.4M |
| G2067 | Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed… | 2 | 30 | 8,280 | $140 | $8M |
| H2015 | Comprehensive community support services, per 15 minutes | 79 | 150 | 7,770 | $140 | $4.8M |
| H0011 | Alcohol and/or drug services; acute detoxification (hospital inpatient) per diem | 4 | 30 | 1,210 | $760 | $3.9M |
| H0010 | Alcohol and/or drug services; sub‑acute detoxification (residential addiction program inpatient) | 4 | 30 | 1,910 | $480 | $3.5M |
| 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… | 55 | 60 | 2,800 | $110 | $659.4K |
| 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… | 1,078 | 1,620 | 580 | $80 | $599.6K |
| 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… | 3 | 10 | 1,140 | $90 | $518.2K |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 1 | 30 | 3,380 | $50 | $460K |
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Other providers in the same ZIP code as Spectrum Health Systems, Inc, ranked by combined Medicare and Medicaid revenue.
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