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

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

Sweetser (NPI 1538122445)

Field	Value
Entity Type	Organization
Organization	Sweetser
Address	50 Moody Street
City	Saco
State	ME
ZIP	04072
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	April 11, 2006

Payer Source	Total Paid
Medicaid	$80.6M
Medicare	$0

Key Findings

SWEETSER is effectively a single-payer Medicaid provider: there is no Medicare billing on file and the provider reports $80.6M in total Medicaid revenue. This concentration means the organization’s financial profile and payor exposure are driven almost entirely by Medicaid reimbursement policy and utilization patterns.

Revenue is highly concentrated in a very small set of codes: the precomputed top 3 Medicaid codes (H0004, H0018, H2011) account for 88.5% of this provider's total Medicaid revenue. Specifically, H0004 represents 47.0% of Medicaid revenue, H0018 represents 32.1%, and H2011 represents 9.4%, indicating a narrow set of services driving the majority of receipts.

The dominant revenue-driving codes indicate the provider operates a mixed behavioral health model combining high-volume outpatient counseling, residential treatment, and crisis services: H0004 is billed for behavioral health counseling and therapy per 15 minutes, H0018 for short-term residential per diem (without room and board), and H2011 for crisis intervention per 15 minutes. This code mix suggests operational emphasis on time-based therapy encounters and per-diem residential care rather than one-off medical procedures.

SWEETSER is a statewide leader for its top codes: H0004 ranks #1 of 290 providers in-state and is described as an "extreme outlier, far above typical state volume for this code" (100th percentile), H0018 ranks #1 of 10 providers (100th percentile) and is "notably above typical state volume for this code", and H2011 ranks #1 of 13 providers (100th percentile) and is also "notably above typical state volume for this code". Those rankings indicate dominant market share in these specific service lines within the state Medicaid population.

There is some service breadth beyond the top three codes but at much lower revenue, indicating specialized ancillary capabilities rather than balanced diversification. For example, H2010 (comprehensive medication services) produces $6.4M and ranks #3 of 49 providers (96th percentile), while H0040 (assertive community treatment) contributes $1.9M and ranks #6 of 9 providers (38th percentile), and T1013 (interpretive services) contributes $410.8K (0.5% of Medicaid revenue) and ranks #12 of 54 providers (79th percentile).

The billing mix—dominated by per-15-minute codes and a large per-diem residential code—creates revenue that is tightly coupled to utilization intensity and daily census for residential care. Because H0004 and H0018 together account for 79.1% of Medicaid revenue (47.0% + 32.1% as reported), shifts in authorization, utilization patterns, or per-diem occupancy would materially affect overall revenue volatility.

SWEETSER’s long tenure in the NPI registry (enumerated 2006-04-11 (~20 years ago)) suggests it is an established provider in the state Medicaid network, which may support sustained referral and payer relationships that underlie the high volumes reported for its core service lines. Long-standing enrollment combined with top-state rankings indicates sustained operational capacity rather than a short-term billing spike.

Despite the concentration in core behavioral health and residential services, revenue from diagnostic testing and typical office E/M codes is minimal. Examples include 96101 at $138.5K (0.2% of Medicaid revenue, ranks #3 of 14 in-state), 99214 at $95.6K (0.1%), and psychotherapy codes such as 90837 at $97.1K (0.1%), which together show that ancillary clinical procedures and traditional evaluation-and-management visits are only a small fraction of the overall Medicaid revenue base.

Medicaid: Complete Services Breakdown

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

17 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0004	Behavioral health counseling and therapy, per 15 minutes	473,760	$80	$37.9M
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	53,490	$480	$25.9M
H2011	Crisis intervention service, per 15 minutes	47,310	$160	$7.6M
H2010	Comprehensive medication services, per 15 minutes	41,240	$150	$6.4M
H0040	Assertive community treatment program, per diem	32,430	$60	$1.9M
T1013	Sign language or oral interpretive services, per 15 minutes	6,630	$60	$410.8K
96101	N/A	650	$210	$138.5K
H2000	Comprehensive multidisciplinary evaluation	1,190	$100	$121.1K
96131	The provider, physician or other qualified healthcare professional, administers standardized psychological tests to a patient, interprets the results, establishes a treatment plan, and prepares a…	420	$240	$100.3K
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…	4,860	$20	$97.1K

Showing 1–10 of 17

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

Sweetser — 5 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

17 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	1	10	5,380	$590	$6.3M
H0040	Assertive community treatment program, per diem	6	10	48,840	$80	$5.6M
H2011	Crisis intervention service, per 15 minutes	1	10	7,180	$310	$4.7M
H2015	Comprehensive community support services, per 15 minutes	66	70	7,120	$100	$1.7M
H2010	Comprehensive medication services, per 15 minutes	3	50	3,690	$130	$1.6M
T1017	Targeted case management, each 15 minutes	84	100	4,690	$90	$1M
H0004	Behavioral health counseling and therapy, per 15 minutes	1	290	860	$80	$805.1K
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…	22	30	1,440	$160	$515.5K
T1013	Sign language or oral interpretive services, per 15 minutes	12	50	740	$90	$453.3K
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…	127	460	1,240	$30	$190K

Showing 1–10 of 17

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sweetser	ME	Mental Illness Community Based Residential Treatment Facility	$0	$98.1M
Sweetser	ME	Community/Behavioral Health Agency	$0	$8.1M
Sweetser	ME	Substance Use Disorder Rehabilitation Clinic/Center	$0	$2.5M
Wendy Ray	ME	Clinical Social Worker	$3.5K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Mainehealth Care At Home	ME	Home Health Agency	$0	$11.3M
Qaisi Homecare Inc	ME	In Home Supportive Care Agency	$0	$9.2M
Everest Recovery Centers - Maine	ME	Substance Use Disorder Rehabilitation Clinic/Center	$147K	$7.9M
Saco School Department	ME	Local Education Agency (LEA)	$0	$1.7M
Island Institute For Trauma Recovery LLC	ME	Community/Behavioral Health Agency	$0	$1.7M
City Of Saco	ME	Ambulance	$269.2K	$1.3M
Maine Medical Partners	ME	Pediatrics Physician	$0	$1.4M
Community Choice Behavioral Health, LLC.	ME	Community/Behavioral Health Agency	$0	$1.3M
Saco Bay Orthopaedic And Sports Physical Therapy, Inc.	ME	Rehabilitation Clinic/Center	$0	$1.3M
Maine Oral Surgery And Dental Implant Center	ME	Oral and Maxillofacial Surgery (Dentist)	$0	$921.8K

Sweetser — Billing Profile & Reimbursement Data

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Sweetser — 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