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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Seneca Health Services Inc (NPI 1518953652)

Field	Value
Entity Type	Organization
Organization	Seneca Health Services Inc
Address	804 Industrial Park Rd
City	Maxwelton
State	WV
ZIP	24957
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	September 23, 2005

Payer Source	Total Paid
Medicaid	$38.1M
Medicare	$0

Key Findings

This provider is effectively single‑payer in the claims data: there is no Medicare billing on file and all recorded lifetime revenue is Medicaid-based, totaling $38.1M. The absence of Medicare activity indicates the organization operates almost entirely within Medicaid-funded programs rather than as a dual‑payer provider serving significant Medicare populations.

Revenue is highly concentrated in a very small set of Medicaid codes: the top three Medicaid codes by revenue account for 88.1% of this provider's total Medicaid revenue. S5125 drives the lion’s share with $28.8M (75.5% of Medicaid revenue), followed by T1005 at $2.4M (6.4%) and G9002 at $2.3M (6.2%), signaling that a few service lines dominate the financial profile.

The billing mix and taxonomy (Developmentally Disabled Services Day Training Agency) point to a service model focused on hands‑on, community and waiver supports: S5125 (attendant care services; per 15 minutes) as the primary revenue driver suggests sustained, per‑time direct support/attendant care delivery, while T1005 (respite care) and G9002 (coordinated care fee, maintenance rate) indicate supplementary respite and coordinated care/case infrastructure billed alongside direct care.

Competitive standing is mixed across service lines: for S5125 the provider ranks #26 of 43 in‑state (40th percentile) and is described as typical/unremarkable volume for that code, indicating a modest participant rather than a dominant provider for attendant care. By contrast, G9002 ranks #12 of 123 in‑state (91th percentile) and is also labeled typical/unremarkable, which nevertheless places the provider relatively strong in coordinated care fees compared with peers statewide.

Volume and payment patterns underline the operational emphasis on time‑based services: S5125 shows 10.3K claims with an average paid/claim of $2789 and $28.8M in revenue, while G9002 has 11.4K claims at $206 avg paid/claim for $2.3M in revenue. These claim counts and per‑claim averages reflect both high utilization of attendant and coordinated care time units and a reliance on aggregation of many small time‑based units to produce overall revenue.

Beyond the top three, the provider bills a range of waiver and support codes consistent with comprehensive community supports: T1016 (case management) has 9.6K claims and $1.6M revenue (4.3%); A0160 (non‑emergency transportation) has 5.5K claims and $1.3M revenue (3.5%); and T1002 (RN services) contributes $576.6K (1.5%). Percentile ranks for these codes (for example T1016 at #17 of 96, 83th percentile and A0160 at #36 of 112, 68th percentile) indicate the provider maintains meaningful but not dominant positions across supportive service lines.

The provider’s enrollment tenure is long-standing: the NPI was enumerated 2005-09-23 (~21 years ago), which suggests an established operational presence in the state Medicaid network and likely stable relationships with payers and waiver programs over time.

The extreme revenue concentration into S5125 (75.5% of Medicaid revenue) and the top three codes collectively making up 88.1% of Medicaid revenue imply limited revenue diversification. This profile means changes to reimbursement, utilization, or authorization of time‑based attendant services could materially affect the provider’s Medicaid revenue stream, given the relatively small number of codes producing most income.

Medicaid: Complete Services Breakdown

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

10 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S5125	Attendant care services; per 15 minutes	10,310	$2,790	$28.8M
T1005	Respite care services, up to 15 minutes	2,170	$1,130	$2.4M
G9002	Coordinated care fee, maintenance rate	11,380	$210	$2.3M
T1016	Case management, each 15 minutes	9,600	$170	$1.6M
A0160	Non-emergency transportation: per mile - case worker or social worker	5,530	$240	$1.3M
T1002	Rn services, up to 15 minutes	3,520	$160	$576.6K
T2021	Day habilitation, waiver; per 15 minutes	5,450	$90	$507.2K
T1003	Lpn/lvn services, up to 15 minutes	1,950	$180	$352.4K
T2024	Service assessment/plan of care development, waiver	2,170	$70	$147.7K
T2025	Waiver services; not otherwise specified (nos)	80	$140	$10.8K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Seneca Health Services Inc — 0 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

10 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5125	Attendant care services; per 15 minutes	26	40	14,820	$750	$30.5M
T2021	Day habilitation, waiver; per 15 minutes	32	60	6,490	$120	$2.2M
T1005	Respite care services, up to 15 minutes	19	30	2,980	$250	$1.5M
G9002	Coordinated care fee, maintenance rate	12	120	2,950	$150	$901.9K
T1003	Lpn/lvn services, up to 15 minutes	18	30	2,070	$90	$522.7K
T1016	Case management, each 15 minutes	17	100	2,790	$90	$496.2K
A0160	Non-emergency transportation: per mile - case worker or social worker	36	110	2,030	$50	$278.8K
T2025	Waiver services; not otherwise specified (nos)	6	10	610	$230	$263.7K
T1002	Rn services, up to 15 minutes	48	150	1,980	$40	$232.6K
T2024	Service assessment/plan of care development, waiver	13	50	760	$50	$95.5K

Nearby Providers

Other providers in the same ZIP code as Seneca Health Services Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Seneca Health Services, Inc.	WV	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$14.1M
Seneca Health Services Inc	WV	Community/Behavioral Health Agency	$0	$2.8M
Rainelle Medical Center, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$1.7M

Seneca Health Services Inc — Billing Profile & Reimbursement Data

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Seneca Health Services 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

Nearby Providers

Frequently Asked Questions

References