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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Horizon Health Care, Inc (NPI 1578672846)

Key Findings

Field	Value
Entity Type	Organization
Organization	Horizon Health Care, Inc
Address	161 S Main
City	Mission
State	SD
ZIP	57555
Taxonomy	Federally Qualified Health Center (FQHC)
NPI Enumerated	August 30, 2006

Payer Source	Total Paid
Medicaid	$9.7M
Medicare	$0

This provider is effectively a Medicaid-focused operation: there is no Medicare billing on file and total Medicaid revenue is $9.7M, indicating heavy reliance on Medicaid as the primary payer. The absence of Medicare activity makes this organization essentially a single-payer (Medicaid) provider for the datasets shown.

Revenue is highly concentrated in a small set of outpatient and preventive codes: 99213 accounts for $4.4M (47.7% of Medicaid revenue), 99214 for $1M (10.8%), and 90471 for $547.5K (5.9%); the precomputed top-3 codes together account for 64.3% of this provider's total Medicaid revenue. This concentration shows that a few visit- and vaccine-related services drive the majority of billed Medicaid dollars.

The code mix is characteristic of a Federally Qualified Health Center delivering primary care and broad preventive services: high-volume established patient E/M codes (99213, 99214), pediatric/adolescent preventive visits (99392, 99391, 99393, 99394), and routine immunizations (90471, 90686, 90670). Complementary point-of-care testing (87804, 87880) and specimen collection codes (36415, 36416) indicate on-site testing and phlebotomy capacity that supports same-day care workflows common to FQHCs.

Competitive standing within South Dakota shows a meaningful in‑state presence for core primary care and immunization services: 99213 ranks #10 of 344 providers (97th percentile), 99214 ranks #26 of 260 (90th percentile), and 90471 ranks #9 of 159 (95th percentile). Although those percentiles are high, the profile labels the volumes for these codes as "typical, unremarkable," suggesting the center is busy relative to peers but operating within normal utilization patterns for an FQHC.

One notable statistical outlier is W0037 (12.9K claims, $129.2K revenue), which ranks #5 of 164 providers (98th percentile) and is described as "notably above typical state volume." Even though W0037 contributes a modest share of total Medicaid revenue (1.4%), its unusually high claim count relative to peers warrants follow-up if an analyst needs to understand operational differences or coding peculiarities.

Payment-per-claim patterns reinforce a mix of high-frequency, moderate-reimbursement visits and lower-value high-count preventive services: 99213 pays $170 avg/claim and 99214 pays $150 avg/claim, while immunization codes such as 90471 pay $82 avg/claim and 90686 pays $110 avg/claim. The combination of the relatively higher per-claim E/M fees with very large claim counts for 99213 points to a practice model driven by numerous established outpatient visits supplemented by routine vaccination clinics.

Ancillary and laboratory activity supports longitudinal primary care: lab-service codes (81003, 85025, 85018, 80053, 83655) and rapid diagnostics (87804, 87880) appear across the top codes with moderate rankings, indicating the provider performs in‑house testing and basic lab work commonly used in ambulatory care. These services collectively suggest operational integration of diagnostics and visit-based care rather than a specialty- or procedure-oriented billing profile.

This provider has a long tenure in the dataset (NPI enumerated on 2006-08-30, ~20 years ago), consistent with an established community-facing FQHC. The extended enumeration period combined with the Medicaid-dominant revenue profile supports the interpretation of a stable primary-care safety-net role in its local market.

Medicaid: Complete Services Breakdown

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

62 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	26,130	$170	$4.4M
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…	6,680	$150	$1M
90471	In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route.	6,680	$80	$547.5K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	1,720	$180	$317.2K
90686	This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL…	2,260	$110	$248.1K
81003	The lab analyst inserts a dip stick into a freshly collected urine specimen, removes the dipstick, and shakes off the excess urine. She places the stick onto a mechanical dip stick reader that will…	1,460	$170	$246.7K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	1,290	$180	$231.7K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	4,770	$50	$219.2K
87804	The analyst performs an immunoassay with direct optical, meaning visual, observation to detect influenza, also called flu, in a patient sample, typically a throat or nasal swab or nasal washings.	1,220	$180	$213K
36416	In this procedure, the provider pricks the patient’s finger, heel, or ear with a pointed instrument and collects specimen of droplets of blood by pressing the pricking site.	2,050	$100	$211.4K

Showing 1–10 of 62

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Horizon Health Care, Inc — 2 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

62 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	10	340	1,010	$100	$511K
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…	26	260	860	$80	$222.6K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	19	40	1,100	$80	$181.3K
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…	44	70	200	$80	$176.7K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	12	50	410	$80	$127.2K
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…	34	70	130	$100	$99K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	37	160	210	$120	$97.4K
36415	In this procedure, the provider inserts a needle into a vein to collect a blood sample.	24	110	990	$20	$82.9K
99393	The provider performs an established well–patient visit for a child who is between the ages of 5 and 11.	13	60	170	$90	$66.3K
99203	The provider sees a new 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 provider…	47	100	160	$60	$64.4K

Showing 1–10 of 62

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sinte Gleska University	SD	Counselor	$0	$55.5K
Briana Broschat	SD	Family Nurse Practitioner	$2.2K	$0

Horizon Health Care, Inc — Billing Profile & Reimbursement Data

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Horizon Health Care, 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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Horizon Health Care Inc.	SD	Federally Qualified Health Center (FQHC)	$0	$3.3M
Horizon Health Care Inc	SD	Federally Qualified Health Center (FQHC)	$0	$3.2M
Horizon Health Care Inc	SD	Federally Qualified Health Center (FQHC)	$0	$2.3M
Horizon Health Care, Inc	SD	Federally Qualified Health Center (FQHC)	$0	$1.2M
Horizon Health Care Inc	SD	Family Medicine Physician	$0	$1.1M
Horizon Health Care Inc	SD	Federally Qualified Health Center (FQHC)	$0	$915.7K
Horizon Health Care Inc	SD	Federally Qualified Health Center (FQHC)	$0	$705.3K
Horizon Health Care Inc	SD	Federally Qualified Health Center (FQHC)	$0	$507.3K
Horizon Health Care Inc	SD	Federally Qualified Health Center (FQHC)	$0	$437.3K
Horizon Health Care Inc	SD	Federally Qualified Health Center (FQHC)	$0	$379.8K