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

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

Specialty Counseling & Consulting (NPI 1538462783)

Field	Value
Entity Type	Organization
Organization	Specialty Counseling & Consulting
Address	4025 Rawlins St
City	Cheyenne
State	WY
ZIP	82001
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	December 9, 2010

Payer Source	Total Paid
Medicaid	$8.2M
Medicare	$0

Key Findings

SPECIALTY COUNSELING & CONSULTING is a community/behavioral health agency in CHEYENNE, WY with an NPI enumerated on 2010-12-09 (~16 years ago), indicating over a decade of formal enrollment in payer systems and likely established local operational capacity. Its taxonomy and tenure align with a sustained behavioral-health service line rather than a recent market entrant or a primarily medical practice.

This provider has no Medicare billing on file while reporting $8.2M in lifetime Medicaid revenue, making its realized payer footprint effectively single-payer Medicaid; analysts should treat Medicaid policy, enrollment, and rate changes as the primary financial levers for this entity. The absence of Medicare activity implies limited exposure to fee-for-service Medicare populations or that services are not credentialed/billed to Medicare.

Revenue is highly concentrated: the top three Medicaid codes account for 78.9% of the provider’s total Medicaid revenue. Those top drivers are H2019 ($2.8M, 34.7%), 90837 ($2.2K claims, $2.2M revenue, 26.6%), and G9012 ($1.4M, 17.6%), so a small set of service lines dominate overall financial performance.

The code mix signals an operational model centered on intensive behavioral-health treatment and high-touch coordination: H2019 (therapeutic behavioral services, per 15 minutes), 90837 (long psychotherapy sessions), and G9012 (other specified case management) together suggest the provider delivers ongoing direct therapy combined with substantial case-management activity. Secondary codes such as T1017 (targeted case management) and H2014 (skills training and development) further reinforce a bundled community behavioral-health service portfolio rather than an acute medical model.

On a statewide competitive basis the provider is a dominant outlier for several lines: it ranks #1 in-state and at the 100th percentile (labeled an "extreme outlier") for H2019, 90837 and G9012, indicating volumes and revenues for these codes are far above typical Wyoming providers. For payers and competitors, this positioning identifies the provider as a major Medicaid supplier of therapy and case-management services in-state rather than a marginal participant.

Operational scale is evident in high claim counts for core services: H2019 has 36K claims, 90837 has 26.2K claims, and G9012 has 33.6K claims, which together reflect sustained, high-frequency delivery models (frequent 15-minute behavioral sessions and many psychotherapy encounters). Additional scale is seen in T1017 with 13.9K claims and H2014 with 5.8K claims, pointing to program-level infrastructure that supports repeated short-interval contacts with members.

Unit payment patterns show relatively low per-claim rates for case-management and short-interval services but offset by volume: average paid/claim is $79 for H2019, $83 for 90837, and $43 for G9012, indicating the provider realizes substantial revenue through throughput rather than high per-encounter reimbursement. The presence of 99214 (3.5K claims, $270.2K revenue, $77 avg paid/claim) also shows some engagement with higher-intensity outpatient evaluation and management within the Medicaid mix, but it represents a modest share (3.3%) of Medicaid revenue.

From a risk/opportunity perspective, the heavy Medicaid concentration means state-level Medicaid policy, prior-authorizations, or case-management program changes could materially shift revenue; conversely, the provider’s dominance in core Medicaid behavioral-health codes positions it well for managed-care contracting and Medicaid behavioral-health program expansion. Telehealth appears present but small (Q3014 $6.5K, 344 claims), while strong rankings on assessment codes such as H0031 and 90791 suggest capacity for intake/diagnostic workflows that feed the higher-volume therapy and case-management streams.

Medicaid: Complete Services Breakdown

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

18 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2019	Therapeutic behavioral services, per 15 minutes	36,020	$80	$2.8M
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…	26,250	$80	$2.2M
G9012	Other specified case management service not elsewhere classified	33,550	$40	$1.4M
T1017	Targeted case management, each 15 minutes	13,930	$40	$529.3K
H2014	Skills training and development, per 15 minutes	5,780	$70	$404.7K
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…	3,510	$80	$270.2K
H0032	Mental health service plan development by non-physician	3,010	$50	$144.4K
H0031	Mental health assessment, by non-physician	1,410	$90	$128.4K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	740	$100	$70.5K
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…	1,060	$70	$69.7K

Showing 1–10 of 18

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wyoming Distribution

Specialty Counseling & Consulting — 7 of 18 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wyoming

Full comparison — all codes billed, vs. Wyoming median

18 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2014	Skills training and development, per 15 minutes	2	10	250	$90	$318.5K
H2019	Therapeutic behavioral services, per 15 minutes	1	170	840	$80	$192.2K
G9012	Other specified case management service not elsewhere classified	1	40	460	$50	$97.8K
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…	1	140	350	$70	$81.5K
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…	19	220	400	$50	$79.3K
H0032	Mental health service plan development by non-physician	1	10	1,550	$50	$74.3K
H2017	Psychosocial rehabilitation services, per 15 minutes	4	10	120	$70	$66.9K
T1017	Targeted case management, each 15 minutes	1	20	240	$40	$57.9K
H0046	Mental health services, not otherwise specified	7	10	930	$30	$42K
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	3	10	480	$20	$41.5K

Showing 1–10 of 18

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Daniel Bort	WY	Mental Health Counselor	$0	$86.4K

Nearby Providers

Other providers in the same ZIP code as Specialty Counseling & Consulting, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Magic City Enterprises, Inc	WY	Developmentally Disabled Services Day Training Agency	$0	$23.6M
Cheyenne Habilitation & Therapeutic Center, Inc	WY	Developmentally Disabled Services Day Training Agency	$0	$14.4M
University Of Wyoming	WY	Federally Qualified Health Center (FQHC)	$0	$5.5M
Cheyenne Regional Physicians Group, LLC	WY	Medical Oncology Physician	$0	$5.1M
Cheyenne Surgical Center LLC	WY	Ambulatory Surgical Clinic/Center	$567.4K	$4.5M
Memorial Hospital Of Laramie County	WY	General Acute Care Hospital	$0	$4M
Goodwill Industries Of Wy, Inc.	WY	Case Management Agency	$0	$3.9M
American Medical Response Ambulance Service Inc	WY	Ambulance	$1.4M	$2.3M
Summit Medical Group, LLC	WY	Emergency Medicine Physician	$0	$3.7M
Memorial Hospital Of Laramie County	WY	Home Health Agency	$0	$3.3M

Specialty Counseling & Consulting — Billing Profile & Reimbursement Data

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Specialty Counseling & Consulting — 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