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

Why is the Medicaid comparison limited to Tennessee 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. Tennessee (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 Of Tennessee, Inc. (NPI 1497721609)

Field	Value
Entity Type	Organization
Organization	Pathways Of Tennessee, Inc.
Address	238 Summar Dr
City	Jackson
State	TN
ZIP	38301
Taxonomy	Clinic/Center
NPI Enumerated	February 27, 2006

Payer Source	Total Paid
Medicaid	$30.6M
Medicare	$0

Key Findings

PATHWAYS OF TENNESSEE, INC. is effectively a Medicaid-focused provider: there is no Medicare billing on file and total reported Medicaid revenue is $30.6M, indicating the organization operates as a single‑payer (Medicaid) entity in these claims datasets. Its NPI was enumerated 2006-02-27 (~20 years ago), signaling a long-established presence in the market.

Revenue is highly concentrated in a very small set of codes: the top three Medicaid codes (S0280, 90837, 90834) together account for 75.8% of the provider’s total Medicaid revenue. Those three codes break down as S0280 $16.6M (54.3%), 90837 $4.2M (13.7%), and 90834 $2.4M (7.8%), which shows the bulk of dollars come from one dominant care coordination/medical home line and two psychotherapy service lines.

The code mix points to a behavioral‑health outpatient operation with a strong emphasis on coordinated care and psychotherapy: S0280 (Medical home program, comprehensive care coordination and planning, initial plan) is the single largest revenue driver and the large volumes on 90837 and 90834 confirm heavy delivery of individual psychotherapy services. Additional reported codes such as 90791 (psychiatric evaluation), H2017 (psychosocial rehabilitation), H0038 (self‑help/peer services), and 90853 (group psychotherapy) fit a profile of a multi‑service behavioral health clinic that combines care coordination, diagnostic evaluations, and individual/group therapy.

Competitive standing within Tennessee varies by service line. For long‑form psychotherapy, 90837 is a clear strength: it ranks #4 of 436 providers in-state (99th percentile) and is labeled “notably above typical state volume,” indicating PATHWAYS is a major statewide provider of extended psychotherapy sessions. By contrast, S0280 (the largest revenue item) ranks #9 of 40 (79th percentile) and is described as “typical, unremarkable volume,” implying the provider’s medical‑home/care‑coordination business is solid but not unusually dominant among the smaller group of providers billing that code.

Clinical evaluation and routine outpatient E/M activity is also significant and appears operationally important: 99213 shows 52.4K claims for $1.8M (5.8% of Medicaid revenue) and ranks #80 of 4050 in-state (98th percentile; labeled “notably above typical state volume”), while 99214 (34.8K claims, $1.5M, 5.0%) ranks #92 of 3759 (98th percentile; labeled “typical, unremarkable volume”). This pattern indicates high-volume, ongoing outpatient management/visit activity that complements the psychotherapy workload and supports longitudinal care delivery.

Several other service lines are present but comparatively small or locally modest: H2017 (psychosocial rehabilitation) generates $475.6K (1.6%) but ranks #18 of 23 (23rd percentile), which suggests limited market share in that specific service; peer/self‑help H0038 and medication administration codes are also reported at lower revenue levels and typical percentiles. These mixed rank signals indicate depth in psychotherapy plus more modest footprint in some ancillary behavioral‑health services.

The combination of concentrated revenue (75.8% from three codes), long tenure since 2006-02-27 (~20 years ago), and very high state ranking on core psychotherapy codes creates both strategic strength and exposure: PATHWAYS appears well‑positioned as a major Medicaid psychotherapy provider in Tennessee, but its heavy reliance on a small set of Medicaid codes means payer rate or policy changes affecting S0280 or psychotherapy coding/pricing could have outsized financial impact. Analysts should treat this as a Medicaid‑dependent operation with concentrated service‑line risk and strong competitive positioning specifically in extended psychotherapy (90837).

Medicaid: Complete Services Breakdown

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

43 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S0280	Medical home program, comprehensive care coordination and planning, initial plan	136,260	$120	$16.6M
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…	59,900	$70	$4.2M
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…	49,710	$50	$2.4M
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…	52,360	$30	$1.8M
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	17,860	$90	$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…	34,750	$40	$1.5M
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	7,500	$80	$577.3K
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…	14,650	$40	$512.7K
H2017	Psychosocial rehabilitation services, per 15 minutes	4,850	$100	$475.6K
99215	The provider sees an established 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…	5,180	$40	$217.4K

Showing 1–10 of 43

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Pathways Of Tennessee, Inc. — 9 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

43 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S0280	Medical home program, comprehensive care coordination and planning, initial plan	9	40	22,180	$140	$21.3M
H2017	Psychosocial rehabilitation services, per 15 minutes	18	20	11,380	$70	$1.9M
H0034	Medication training and support, per 15 minutes	12	20	610	$60	$421.5K
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	360	350	$50	$414.4K
H0038	Self‑help/peer services, per 15 minutes	8	30	1,450	$40	$310.3K
H0033	Oral medication administration, direct observation	44	100	340	$150	$306.9K
S9485	Crisis intervention mental health services, per diem	3	20	1,410	$60	$291.9K
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…	4	440	530	$70	$282.3K
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…	24	300	480	$30	$221.2K
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…	92	3,760	610	$40	$202.3K

Showing 1–10 of 43

Related Providers

Other providers that share a Tax Identification Number (TIN) with Pathways Of Tennessee, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pathways Of Tennessee, Inc.	TN	Psychiatric Hospital	$0	$3.3M
Twana Miller	TN	Clinical Social Worker	$52.4K	$603K
David Helm	TN	Psychiatry Physician	$74.5K	$0
Indria Clay	MN	Clinical Social Worker	$57.8K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jackson Madison County General Hospital	TN	General Acute Care Hospital	$0	$46.6M
Emergency Medical Care Facilities PC	TN	Emergency Medicine Physician	$0	$19.7M
A Plus Care Solutions Incorporated	TN	In Home Supportive Care Agency	$0	$18.4M
Jackson-madison County General Hospital	TN	Land Ambulance	$5.1M	$13M
Mid-south Perinatal Associates PC	TN	Maternal & Fetal Medicine Physician	$0	$11.6M
West Tennessee Medical Group Inc	TN	Internal Medicine Physician	$0	$8.2M
Wt University Medical Associates Inc	TN	Family Medicine Physician	$0	$7.5M
Jackson-madison County General Hospital	TN	Community/Retail Pharmacy	$0	$7.4M
Shavetta Conner	TN	Public Health & General Preventive Medicine Physician	$8.1K	$4.9M
West Tennessee Healthcare Hospitalists Inc	TN	Hospitalist Physician	$0	$4.3M

Pathways Of Tennessee, Inc. — Billing Profile & Reimbursement Data

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Pathways Of Tennessee, 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

Related Providers

Nearby Providers

Frequently Asked Questions

References