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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Carolina Outreach, LLC (NPI 1508171216)

Field	Value
Entity Type	Organization
Organization	Carolina Outreach, LLC
Address	1823 Chapel Hill Rd
City	Durham
State	NC
ZIP	27707
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	August 18, 2010

Payer Source	Total Paid
Medicaid	$47.6M
Medicare	$0

Key Findings

CAROLINA OUTREACH, LLC is effectively a single-payer Medicaid provider: there is no Medicare billing on file while total Medicaid revenue is $47.6M. This concentration makes Medicaid the sole financial driver visible in claims data and indicates analysts should treat this profile as Medicaid-focused when assessing payer risk and contracting exposure.

Revenue is highly concentrated in three programmatic codes: H2022 accounts for $16.7M (35.0%), H0040 accounts for $14.3M (30.0%), and H2015 accounts for $11.8M (24.7%), with the top three codes representing 89.7% of the provider’s total Medicaid revenue. Those three codes’ combination of per-diem and time-based billing explains the bulk of the $47.6M Medicaid footprint and signals program-level revenue dependency rather than diversified fee-for-service income.

The code mix (H2022, H0040, H2015) and their descriptions point to a predominantly community-based behavioral health operating model: wrap-around services, assertive community treatment, and comprehensive community support billed on per-diem or per-15-minute bases. This pattern suggests the organization runs structured programs and team-based community services rather than primarily office-based episodic care.

On competitive standing for its top program codes, the provider ranks at the high end statewide: H2022 is #7 of 216 providers (97th percentile), H0040 is #5 of 119 providers (97th percentile), and H2015 is #8 of 251 providers (97th percentile). These ranks and percentiles indicate CAROLINA OUTREACH is a major in-state operator for intensive community-treatment program billing and is notably above typical state volume for those services.

Psychotherapy and E/M activity is present but much smaller in revenue share; 90837 generates $2.4M (5.0%) from 28K claims and ranks #36 of 1709 providers (98th percentile), indicating substantial psychotherapy throughput alongside program billing. By contrast, typical office E/M 99214 contributes $780K (1.6%) and is a more modest component of revenue, consistent with a program-centric service mix rather than a high-volume outpatient clinic model.

The provider has sustained presence in the market with an NPI enumeration date of 2010-08-18 (~16 years ago), which supports that these program volumes reflect an established operation rather than a recent build-up. Tenure may correlate with steady contract relationships or long-running program authorizations that underpin large per-diem claim volumes.

Not all billed services are outsize: several codes show typical or below-peak participation—H0038 ($1M, 2.2%) ranks in the 59th percentile (127 of 309), T2016 ($216.1K, 0.5%) is at the 18th percentile (76 of 92), and T1017 carries $0 revenue and ranks at the 6th percentile (74 claims shown with $0 paid). These contrasts underline that the provider’s footprint is concentrated in a narrow set of high-volume program codes while many ancillary services remain average or low-volume in the state context.

For payer review and contracting, the operational implication of the data is clear: monitoring and oversight should prioritize per-diem and time-based program utilization (H2022, H0040, H2015) given they drive 89.7% of Medicaid revenue and account for tens of thousands of claims (e.g., 77.4K claims for H2015, 65.2K for H0040, 63.4K for H2022). Validation efforts that focus on program eligibility, per-diem days and units of time-based services will address the largest components of financial exposure in this profile.

Medicaid: Complete Services Breakdown

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

22 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2022	Community-based wrap-around services, per diem	63,390	$260	$16.7M
H0040	Assertive community treatment program, per diem	65,170	$220	$14.3M
H2015	Comprehensive community support services, per 15 minutes	77,380	$150	$11.8M
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…	27,970	$90	$2.4M
H0038	Self‑help/peer services, per 15 minutes	4,230	$240	$1M
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…	8,480	$90	$780K
T1023	Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter	940	$230	$217.8K
T2016	Habilitation, residential, waiver; per diem	530	$410	$216.1K
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	2,810	$60	$177.3K
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…	530	$80	$39.8K

Showing 1–10 of 22

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Carolina Outreach, LLC — 4 of 20 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

22 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0040	Assertive community treatment program, per diem	5	120	15,180	$230	$5M
H2022	Community-based wrap-around services, per diem	7	220	3,330	$290	$3.3M
H2015	Comprehensive community support services, per 15 minutes	8	250	10,060	$130	$2.4M
T2016	Habilitation, residential, waiver; per diem	76	90	5,520	$190	$1.6M
H0038	Self‑help/peer services, per 15 minutes	127	310	2,820	$120	$1.3M
T1017	Targeted case management, each 15 minutes	204	220	1,700	$150	$1.3M
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	157	360	1,830	$40	$819.8K
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…	36	1,710	810	$80	$274.5K
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…	538	4,400	960	$60	$271.3K
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…	2,560	4,130	670	$50	$219.9K

Showing 1–10 of 22

Related Providers

Other providers that share a Tax Identification Number (TIN) with Carolina Outreach, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Carolina Outreach, LLC	NC	Community/Behavioral Health Agency	$0	$8.9M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Alpha Management Services, Inc.	NC	Community/Behavioral Health Agency	$0	$18.9M
Lincoln Community Health Center Incorporated	NC	Federally Qualified Health Center (FQHC)	$0	$18.1M
Alpha Management Community Services, Inc	NC	Community/Behavioral Health Agency	$0	$14.7M
Youth Extensions Inc.	NC	Community/Behavioral Health Agency	$0	$14.4M
Maxim Healthcare Services, Inc.	NC	Home Health Agency	$0	$10.7M
Tonya Omar, PLLC	NC	Community/Behavioral Health Agency	$0	$9.7M
Emerge-a Child's Place, PLLC	NC	Speech-Language Pathologist	$0	$9.6M
Quality Life Home Health Care LLC	NC	Home Health Agency	$0	$9M
Easter Seals Ucp North Carolina & Virginia, Inc.	NC	Community/Behavioral Health Agency	$0	$8.3M
Securing Resources For Consumers, Inc.	NC	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$7.1M

Carolina Outreach, LLC — Billing Profile & Reimbursement Data

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Carolina Outreach, LLC — 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