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

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

Swope Health Services (NPI 1619419835)

Field	Value
Entity Type	Organization
Organization	Swope Health Services
Address	3801 Dr Martin Luther King Jr Blvd
City	Kansas City
State	MO
ZIP	64130
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	November 7, 2016

Payer Source	Total Paid
Medicaid	$135.5M
Medicare	$0

Key Findings

SWOPE HEALTH SERVICES is effectively a single-payer Medicaid provider: there is no Medicare billing on file and lifetime Medicaid revenue is $135.5M. The provider’s scale is therefore concentrated entirely in Medicaid-covered services rather than a mixed Medicare/Medicaid model, indicating operations and revenue depend on Medicaid reimbursement streams.

Revenue concentration is extreme: the precomputed top 3 Medicaid codes account for 99.8% of the provider’s total Medicaid revenue, with T1040 alone accounting for $134.8M (99.4% of the total). This pattern indicates that a single per-diem community behavioral health clinic service drives virtually all billed Medicaid dollars.

The top revenue driver, T1040 (481.4K claims, $280 avg paid/claim, $134.8M revenue), reflects operation as a Medicaid-certified community behavioral health clinic providing daily/per-diem services. Despite the enormous revenue tied to T1040, SWOPE ranks #10 of 31 providers in-state for that code (70th percentile; typical, unremarkable volume), so its T1040 revenue dominance is due more to high utilization within its own footprint than to an exceptional statewide market position.

Several evaluation and psychotherapy codes show high claim volume relative to peers but make up a tiny share of revenue: 99213 (34K claims, $7 avg paid/claim, $237.7K revenue) and 99214 (15.4K claims, $11 avg paid/claim, $169.6K revenue) are part of the top-three revenue drivers but together only represent 0.3% of Medicaid revenue while ranking at very high percentiles (99213: #44 of 4312, 99th percentile, labeled an extreme outlier; 99214: #67 of 3166, 98th percentile). This suggests the provider reports large volumes of low-dollar E/M visits in addition to its per-diem clinic services.

Other behavioral health services (for example 90834: 13.2K claims, $8 avg paid/claim, $105.6K revenue, rank #15 of 1059, 99th percentile; 90791: 5K claims, $19 avg paid/claim, $94.1K revenue, rank #3 of 351, 99th percentile) further confirm a clinical mix centered on psychotherapy and psychiatric evaluation, with high relative statewide volume for those encounter types even though they comprise a small share of overall Medicaid dollars.

Reporting also shows large claim counts for many H-codes that carry $0 avg paid/claim and $0 revenue (examples include H0036: 214K claims; H2017: 54.9K claims; H0025: 36.2K claims). These zero-paid items indicate substantial recorded activity in community-support and rehabilitation categories that are not appearing as paid Medicaid revenue in the dataset, which could reflect bundled payments, alternative reimbursement arrangements, or data-reporting differences rather than absence of service delivery.

Competitive standing is mixed depending on the lens: by Medicaid dollars SWOPE’s $135.5M footprint is driven almost entirely by one code and is not clearly dominant statewide for that code (T1040 ranks #10 of 31, 70th percentile). However, the provider is a notable outlier on several encounter-level codes (multiple ranks in the 98th–99th percentiles), indicating it is an unusually high-volume provider of specific behavioral health encounters compared with most in-state peers.

SWOPE’s NPI has been enumerated since 2016-11-07 (~10 years ago), providing roughly a decade of recorded activity; given that tenure and the concentration of billed dollars in T1040, the organization appears established in the state’s community behavioral health clinic network with revenue and service patterns centered on per-diem clinic operations rather than diversified Medicare/Medicaid streams.

Medicaid: Complete Services Breakdown

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

26 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1040	Medicaid certified community behavioral health clinic services, per diem	481,430	$280	$134.8M
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…	33,960	$10	$237.7K
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…	15,420	$10	$169.6K
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…	13,200	$10	$105.6K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	4,950	$20	$94.1K
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…	3,230	$20	$74.4K
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…	8,350	$10	$50.1K
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…	1,200	$10	$9.6K
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…	630	$10	$3.8K
90846	A provider meets with the patient’s family without the patient present to counsel the family on the psychological issues affecting the patient and the family.	90	$10	$1.1K

Showing 1–10 of 26

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Missouri Distribution

Swope Health Services — 6 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Missouri

Full comparison — all codes billed, vs. Missouri median

26 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1040	Medicaid certified community behavioral health clinic services, per diem	10	30	198,100	$260	$125.7M
H0037	Community psychiatric supportive treatment program, per diem	10	20	56,420	$120	$11.7M
H0036	Community psychiatric supportive treatment, face-to-face, per 15 minutes	12	20	214,040	$20	$10.8M
H2015	Comprehensive community support services, per 15 minutes	15	20	4,550	$50	$2.5M
H2017	Psychosocial rehabilitation services, per 15 minutes	10	20	40,460	$20	$2M
H2012	Behavioral health day treatment, per hour	11	10	33,050	$30	$1.9M
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…	8	10	1,150	$160	$1.4M
H0001	Alcohol and/or drug assessment	8	10	380	$280	$1.1M
H0004	Behavioral health counseling and therapy, per 15 minutes	29	40	3,680	$30	$978K
H0005	Alcohol and/or drug services; group counseling by a clinician	13	20	16,420	$20	$858.5K

Showing 1–10 of 26

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Crystal Home Care LLC	MO	Home Health Agency	$0	$27.9M
Lives Without Limits	MO	Community/Behavioral Health Agency	$0	$23.1M
Swope Health Services	MO	Federally Qualified Health Center (FQHC)	$0	$9.3M
Heather Newhard	MO	Foot & Ankle Surgery Podiatrist	$48.5K	$0
Stephanie Sanderson	MO	Clinical Social Worker	$41.6K	$0

Swope Health Services — Billing Profile & Reimbursement Data

Sign up for Swope Health Services — Billing Profile & Reimbursement Data policy alerts

Swope Health Services — Billing Profile & Reimbursement Data

Sign up for Swope Health Services — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References