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

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

Edgewater Recovery Center LLC (NPI 1619466141)

Field	Value
Entity Type	Organization
Organization	Edgewater Recovery Center LLC
Address	259 Old Flemingsburg Rd
City	Morehead
State	KY
ZIP	40351
Taxonomy	Substance Abuse Rehabilitation Facility
NPI Enumerated	May 10, 2018

Payer Source	Total Paid
Medicaid	$50.3M
Medicare	$0

Key Findings

EDGEWATER RECOVERY CENTER LLC appears to be effectively a single-payer provider: there is no Medicare billing on file and the provider reports $50.3M in lifetime Medicaid revenue. This heavy reliance on Medicaid revenue makes the organization highly dependent on state behavioral health contracting and reimbursement rules rather than Medicare dynamics.

Revenue is highly concentrated in a small set of service lines: the precomputed top 3 Medicaid codes account for 61.2% of the provider’s total Medicaid revenue. Those top three codes are H0011 ($15M; 29.8%), H2034 ($10.7M; 21.3%), and H0035 ($5.1M; 10.1%), indicating that a majority of dollars come from acute detox/residential, halfway-house per diem, and partial hospitalization services.

The code mix signals a service model centered on residential and transitional addiction care combined with structured outpatient programs. H0011 is described as acute detoxification in a residential addiction program, H2034 is halfway house per diem, and H0035 is partial hospitalization; together these suggest the organization operates a continuum from inpatient/residential detox through transitional housing and day-treatment services.

Several Medicaid codes show above-average in-state standing for specific service lines. H2034 ranks #3 of 38 providers in-state (95th percentile), which positions the provider as a leading statewide provider of halfway-house services; H0011 and H0035 both rank in the 85th percentile (H0011 #12 of 72; H0035 #9 of 56), which is consistent with higher-than-typical but not dominant volumes for those residential/partial hospitalization services.

EDGEWATER reports an unusually large volume of peer/self-help services: H0038 has 180.7K claims, $26 avg paid/claim, $4.7M revenue (9.3%) and ranks #3 of 320 providers in-state (99th percentile) and is labeled an extreme outlier, far above typical state volume for this code. That extreme outlier status indicates an operational emphasis on self-help/peer interventions and very high claim frequency in that category relative to peers.

Other mid-revenue behavioral service lines support the residential core and demonstrate program breadth: H2027 (psychoeducational service) contributed $4.9M (9.7%) and ranks #5 of 220 (98th percentile, labeled typical), while H0015 (intensive outpatient) generated $4.8M (9.6%) and ranks #7 of 225 (97th percentile, described as notably above typical state volume). These codes imply both group-based education and formal intensive outpatient programming are meaningful parts of the operating model.

Per-claim payment patterns align with a predominance of per-diem and program-based reimbursement rather than brief office visits: H0011 shows $264 avg paid/claim, H2034 $239 avg paid/claim, and H0035 $169 avg paid/claim, reflecting higher per-encounter payments typical of residential and day-treatment services. Lower-value, high-frequency items like H0038 ($26 avg paid/claim) also contribute materially to revenues through volume rather than per-claim price.

The organization has demonstrated multi-year presence under its NPI (enumerated 2018-05-10, ~8 years ago) and has accumulated $50.3M in Medicaid revenue, indicating a mid-size, established in-state player in substance abuse rehabilitation. Traditional outpatient/clinical CPTs appear only as small revenue contributors (for example, 90853 $331.7K, 0.7% of revenue; 99213 $77.3K, 0.2%), reinforcing that the business is focused on addiction-specific residential, transitional, and program-based services rather than physician-office-driven E/M care.

Medicaid: Complete Services Breakdown

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

22 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0011	Alcohol and/or drug services; acute detoxification (hospital inpatient) per diem	56,830	$260	$15M
H2034	Alcohol and/or drug abuse halfway house services, per diem	44,810	$240	$10.7M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	30,110	$170	$5.1M
H2027	Psychoeducational service, per 15 minutes	46,380	$110	$4.9M
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…	43,170	$110	$4.8M
H0038	Self‑help/peer services, per 15 minutes	180,730	$30	$4.7M
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	12,550	$190	$2.4M
T2023	Targeted case management; per month	6,070	$320	$2M
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…	4,250	$80	$331.7K
T1007	Alcohol and/or substance abuse services, treatment plan development and/or modification	3,830	$60	$218.4K

Showing 1–10 of 22

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Edgewater Recovery Center LLC — 3 of 22 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

22 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0011	Alcohol and/or drug services; acute detoxification (hospital inpatient) per diem	12	70	7,180	$270	$6.8M
H2034	Alcohol and/or drug abuse halfway house services, per diem	3	40	3,120	$220	$3M
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	13	50	4,480	$220	$2.4M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	9	60	3,270	$170	$2.2M
H2027	Psychoeducational service, per 15 minutes	5	220	970	$170	$1.1M
T2023	Targeted case management; per month	63	530	530	$300	$1.1M
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…	7	230	1,750	$110	$793.5K
H0038	Self‑help/peer services, per 15 minutes	3	320	3,070	$50	$678.3K
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…	828	1,270	760	$80	$447.2K
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…	1,318	3,340	1,020	$30	$296K

Showing 1–10 of 22

Nearby Providers

Other providers in the same ZIP code as Edgewater Recovery Center LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Claire Medical Center Inc	KY	General Acute Care Hospital	$0	$71.2M
D&s Residential Services, LP	KY	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$33.6M
Gateway Area Development District	KY	Supports Brokerage Agency	$0	$20.8M
St Claire Medical Center Inc.	KY	Emergency Medicine Physician	$0	$4M
Lincare Inc.	KY	Durable Medical Equipment & Medical Supplies	$0	$3.4M
St. Claire Medical Center, Inc	KY	Family Medicine Physician	$0	$3.3M
St Claire Medical Center, Inc	KY	Urgent Care Clinic/Center	$0	$3.3M
St Claire Medical Center, Inc.,	KY	Cardiovascular Disease Physician	$0	$3.3M
St. Claire Medical Center, Inc	KY	Home Health Agency	$0	$3.1M
Rowan County Fiscal Court	KY	Land Ambulance	$384.7K	$767.5K

Edgewater Recovery Center LLC — 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