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

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

Pathways (NPI 1487683546)

Field	Value
Entity Type	Organization
Organization	Pathways
Address	200 W Spring St
City	Marquette
State	MI
ZIP	49855
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	July 1, 2006

Payer Source	Total Paid
Medicaid	$89.1M
Medicare	$0

Key Findings

This provider is effectively a Medicaid-focused operation: there is no Medicare billing on file while total Medicaid revenue is $89.1M, so Medicaid accounts for the entirety of reported lifetime federal program revenue. The absence of Medicare activity indicates the organization operates primarily within state Medicaid programs rather than as a mixed Medicare/Medicaid outpatient provider.

Revenue is highly concentrated in a small set of community-focused codes: the precomputed top three Medicaid codes (H2015, T1017, H0039) account for 46.0% of this provider’s total Medicaid revenue. Those three codes individually are H2015 $17.3M (19.9%), T1017 $13.1M (15.1%), and H0039 $9.5M (11.0%), signalling that community support, targeted case management, and assertive community treatment are the principal revenue drivers.

The code mix points to a community mental health and outreach model rather than a clinic focused solely on office-based psychopharmacology: heavy billing for H2015 (comprehensive community support services), T1017 (targeted case management), and H0039 (assertive community treatment) indicates sustained investment in in‑community, multi‑disciplinary service delivery and care coordination. Complementary codes such as H2000 ($2.5M) and H2030 ($3.4M) further support the presence of structured multidisciplinary evaluations and clubhouse/rehabilitation services.

Psychotherapy and office-based evaluation also represent meaningful revenue lines: 90837 is $6.9M (7.9%) and is described as notably above typical state volume for this code (rank #42 of 1956, 98th percentile), while 90834 is $2.7M (3.1%) and ranks in the 92nd percentile. In addition, evaluation and management codes 99213 ($2.5M) and 99214 ($2.3M) show high state percentiles (89th and 86th respectively), indicating the provider maintains substantial clinic-based visit volume alongside community services.

The provider’s statewide competitive standing is mixed: for several high-revenue community codes (H2015 and T1017) the provider’s volume ranks in the upper but not dominant tier (H2015 rank #99 of 614, 84th percentile; T1017 rank #50 of 175, 72th percentile) and are labeled as typical, unremarkable volume for those codes. By contrast, the provider is a comparatively prominent source of long psychotherapy sessions (90837 at the 98th percentile) and has a strong presence in assertive community treatment by rank (H0039 rank #8 of 67, 89th percentile), indicating pockets of above-average specialization within the broader Medicaid market.

Operational implications flow from concentration and service mix: with 46.0% of Medicaid revenue coming from three community-based codes, the organization’s financial performance is sensitive to reimbursement or utilization changes affecting H2015, T1017, and H0039. At the same time, the combination of high-volume psychotherapy (90837) and solid E/M activity (99213/99214) suggests capacity to balance community outreach revenue with billable clinic encounters.

The breadth of billed services—ranging from assertive community treatment (H0039, $9.5M) to adaptive behavior treatment (97153, $3.0M) and high‑unit evaluation codes (H2000, $2.5M; 90792, $1.1M)—indicates a multidisciplinary staffing model with clinicians, case managers, and technicians. Several of these codes are in typical state volume ranges (many listed as typical, unremarkable), which implies the provider operates at scale consistent with community mental health centers rather than as an outlier network model.

This is an established entity: the NPI was enumerated on 2006-07-01 (~20 years ago), which supports interpretation of these patterns as the product of a multi‑year operational footprint in Michigan’s Medicaid behavioral health system rather than a recent entrant or transient billing spike.

Medicaid: Complete Services Breakdown

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

42 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2015	Comprehensive community support services, per 15 minutes	85,200	$200	$17.3M
T1017	Targeted case management, each 15 minutes	42,160	$310	$13.1M
H0039	Assertive community treatment, face-to-face, per 15 minutes	57,410	$170	$9.5M
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…	27,230	$250	$6.9M
T1016	Case management, each 15 minutes	28,320	$210	$5.9M
H2030	Mental health clubhouse services, per 15 minutes	10,950	$310	$3.4M
97153	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	6,440	$470	$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…	13,890	$190	$2.7M
H2000	Comprehensive multidisciplinary evaluation	820	$3,080	$2.5M
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…	11,500	$220	$2.5M

Showing 1–10 of 42

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Michigan Distribution

Pathways — 1 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. Michigan median

42 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1017	Targeted case management, each 15 minutes	50	180	10,890	$210	$8.1M
97153	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	84	130	11,590	$190	$7.6M
H2015	Comprehensive community support services, per 15 minutes	99	610	14,740	$90	$6M
H0039	Assertive community treatment, face-to-face, per 15 minutes	8	70	20,710	$180	$5.1M
H0036	Community psychiatric supportive treatment, face-to-face, per 15 minutes	47	90	8,750	$300	$4.7M
H2014	Skills training and development, per 15 minutes	118	130	20,660	$50	$3.8M
T1016	Case management, each 15 minutes	22	120	8,060	$210	$3.4M
H2030	Mental health clubhouse services, per 15 minutes	37	60	22,740	$80	$2.3M
97155	The provider, a physician or other qualified healthcare professional, administers adaptive behavior treatment face–to–face with one patient and makes modifications in the protocol targets and…	101	130	3,170	$180	$2.2M
H2019	Therapeutic behavioral services, per 15 minutes	22	30	3,330	$200	$1.6M

Showing 1–10 of 42

Nearby Providers

Other providers in the same ZIP code as Pathways, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Adult Learning Systems-u.p.	MI	Intellectual Disabilities Intermediate Care Facility	$0	$65.8M
Dlp Marquette Physician Practices Inc	MI	Obesity Medicine (Internal Medicine) Physician	$0	$17.8M
Dlp Marquette General Hospital LLC	MI	General Acute Care Hospital	$0	$16.3M
Great Lakes Recovery Centers	MI	Substance Use Disorder Rehabilitation Clinic/Center	$0	$8M
Prac Holdings, Inc.	MI	In Home Supportive Care Agency	$0	$6M
Upper Michigan Associates LLC	MI	Ambulatory Surgical Clinic/Center	$1.4M	$0
Nelson Winkler	MI	Ophthalmology Physician	$1M	$0
Sean Rooney	MI	Ophthalmology Physician	$843.7K	$0
Zachary Leonard	MI	Orthopaedic Surgery Physician	$220.4K	$0
Keith Connolly	MI	Orthopaedic Surgery Physician	$197.8K	$0

Pathways — Billing Profile & Reimbursement Data

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Pathways — 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