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

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

St. Monica's (NPI 1629120191)

Field	Value
Entity Type	Organization
Organization	St. Monica's
Address	120 Wedgewood Dr
City	Lincoln
State	NE
ZIP	68510
Taxonomy	Substance Abuse Rehabilitation Facility
NPI Enumerated	January 17, 2007

Payer Source	Total Paid
Medicaid	$7.1M
Medicare	$0

Key Findings

ST. MONICA'S operates primarily as a substance abuse residential treatment provider: its top Medicaid revenue drivers are H0018 (short-term residential, per diem) and H0019 (long-term residential, per diem), which together account for the vast majority of Medicaid receipts and indicate the facility focuses on inpatient-style behavioral health stays rather than outpatient medical treatment. The presence of per-diem residential codes as the top earners suggests the operation is structured around room-and-board–adjacent treatment episodes delivered in a non-hospital residential setting.

Medicaid revenue is the sole recorded public-payer activity for this provider; the profile shows no Medicare billing on file and total Medicaid revenue of $7.1M, effectively making ST. MONICA'S a single-payer (Medicaid-focused) provider in the publicly reported dataset. Analysts should treat its public-revenue footprint as concentrated in state Medicaid program flows rather than split across Medicare and Medicaid.

Revenue concentration is extreme: the precomputed top three Medicaid codes account for 99.1% of the provider's Medicaid revenue, with H0018 representing $3.9M (54.5% of Medicaid revenue) and H0019 representing $3.1M (43.8%). This concentration implies that margins, cash flow, and utilization trends for ST. MONICA'S will be highly sensitive to policy, rate, or utilization changes affecting residential behavioral health per-diem reimbursement.

Competitive standing for the largest codes is modest to typical within Nebraska. For H0018, ST. MONICA'S ranks #10 of 17 in-state (44th percentile), indicating typical volume relative to peers for short-term residential per-diem services. For H0019, it ranks #5 of 6 (20th percentile), which positions the provider toward the lower end among peers billing long-term residential per-diem in-state, suggesting it is not a dominant long-term residential provider in Nebraska.

The code-level mix beyond the top two residential codes is small and oriented toward supportive outpatient or ancillary services: H2015 (comprehensive community support services) accounts for $56.7K (0.8% of Medicaid revenue), 90837 psychotherapy accounts for $36K (0.5%), and H0038 self-help/peer services accounts for $31.7K (0.4%). These smaller line items indicate that while ST. MONICA'S offers some community-based and psychotherapy services, they are marginal contributors to revenue compared with residential per-diem care.

Tenure is long-standing: the provider's NPI was enumerated on 2007-01-17 (approximately 19 years ago), indicating an established presence in the market and a sustained Medicaid billing history that can support longitudinal analyses of utilization and reimbursement for residential behavioral health.

Given the high revenue concentration in H0018 and H0019, payers and network managers should view ST. MONICA'S as a specialist residential behavioral health provider whose financial and utilization profile will be highly correlated with Medicaid residential per-diem policy and capacity constraints; contingency planning for capacity shifts in short- versus long-term residential care would be particularly relevant.

Medicaid: Complete Services Breakdown

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

5 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	1,170	$3,330	$3.9M
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	1,070	$2,920	$3.1M
H2015	Comprehensive community support services, per 15 minutes	890	$60	$56.7K
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…	310	$120	$36K
H0038	Self‑help/peer services, per 15 minutes	2,260	$10	$31.7K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Nebraska Distribution

St. Monica's — 0 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Nebraska

Full comparison — all codes billed, vs. Nebraska median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	5	10	2,070	$270	$4.4M
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	10	20	1,430	$580	$2.6M
H2015	Comprehensive community support services, per 15 minutes	23	30	3,690	$100	$1.1M
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…	292	510	440	$140	$155.7K
H0038	Self‑help/peer services, per 15 minutes	7	20	1,050	$40	$72.9K

Nearby Providers

Other providers in the same ZIP code as St. Monica's, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Saint Elizabeth Regional Medical Center	NE	General Acute Care Hospital	$0	$14.9M
Hopespoke	NE	Community/Behavioral Health Agency	$0	$3.9M
Centerpointe, Inc.	NE	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$3.7M
Bluestem Health	NE	Federally Qualified Health Center (FQHC)	$0	$3.6M
Lincoln Medical Education Partnership	NE	Family Medicine Physician	$0	$3.2M
Hopespoke	NE	Community/Behavioral Health Agency	$0	$2.9M
Lincoln-lancaster County Health Department	NE	Public Health or Welfare Agency	$0	$2.7M
Chi Health Clinic Specialty, LLC	NE	Hospitalist Physician	$0	$2.6M
Eyes On Lincoln	NE	Optometrist	$0	$2.6M
Heartland Urgent Care LP	NE	Urgent Care Clinic/Center	$0	$2.5M

St. Monica's — Billing Profile & Reimbursement Data

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St. Monica's — 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