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

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

Heritage Behavioral Health Center Inc. (NPI 1639231731)

Field	Value
Entity Type	Organization
Organization	Heritage Behavioral Health Center Inc.
Address	151 N Main Street
City	Decatur
State	IL
ZIP	62523
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	December 14, 2006

Payer Source	Total Paid
Medicaid	$28.8M
Medicare	$0

Key Findings

This provider is effectively a single-payer Medicaid operation: there is no Medicare billing on file and all reported lifetime revenue is Medicaid-focused ($28.8M). Analysts should treat Medicare-related network or reimbursement changes as immaterial to this facility’s current revenue base.

The facility has long tenure in the dataset, with its NPI enumerated on 2006-12-14 (~20 years ago), indicating two decades of billing history to evaluate for trend analysis, credentialing consistency, and network participation.

Revenue is highly concentrated in a small set of community-based mental health codes: the top 3 Medicaid codes by revenue account for 61.3% of this provider's total Medicaid revenue, driven by H0039 ($7.6M, 26.4%), H2015 ($5.7M, 19.6%), and H0004 ($4.4M, 15.3%). This concentration means a majority of dollars flow through time-based community support and therapy services rather than a broad mix of disparate procedure lines.

The code mix and volumes point to a community mental health/behavioral health clinic model emphasizing intensive, team-based, face-to-face services: large claim counts for H0039 (76.8K claims) and H2015 (74.4K claims) reflect assertive community treatment and comprehensive community support billed in 15-minute increments, alongside high volumes of behavioral health counseling H0004 (53.2K claims) and comprehensive multidisciplinary evaluation H2000 (44.5K claims). Together these patterns are consistent with ambulatory, community-oriented service lines and ongoing case-management and care-coordination activity.

Competitive standing within Illinois varies by service line. The provider ranks #4 of 47 for H0039 in-state (93rd percentile) but that code is described as "typical, unremarkable volume" for similar providers; by contrast H2015 (rank #22 of 431, 95th percentile) and H0004 (rank #36 of 804, 96th percentile) are characterized as notably above typical state volume, indicating stronger-than-average presence in comprehensive community support and therapy compared with most peers.

Several service lines are statistical outliers or demonstrably above peers and deserve focused attention: H2010 (comprehensive medication services) ranks #6 of 250 (98th percentile) and is labeled an "extreme outlier," despite representing $922.9K (3.2%) of Medicaid revenue and 35.5K claims, which suggests especially high medication-service throughput relative to peer programs. Likewise, H2000 ranks #12 of 423 (97th percentile) and is noted as "notably above typical," signaling above-average use of multidisciplinary evaluations as part of this provider’s workflow.

Crisis and care-coordination services are meaningful secondary revenue drivers: H2011 (crisis intervention) and T1016 (case management) each account for roughly $2.2M (~7–8% of Medicaid revenue) and sit in the 90th–95th percentiles for in-state ranks, described as typical or unremarkable for those codes; S9484 (crisis intervention per hour) contributes $1.2M and is in the 83rd percentile. This mix indicates a sustained operational emphasis on crisis response and active case management alongside ongoing community supports.

For payers and contracting teams, the combination of heavy Medicaid dependence, a concentrated revenue footprint (61.3% in three codes), and several high-percentile/outlier code positions suggests that changes to Medicaid policy, reimbursement for time-based community services, or utilization management on H0039/H2015/H0004/H2010 could materially affect the provider’s cash flow. Given no Medicare exposure, payer oversight, contract design, and performance monitoring efforts should prioritize the high-volume Medicaid service lines and the identified outlier codes.

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
H0039	Assertive community treatment, face-to-face, per 15 minutes	76,830	$100	$7.6M
H2015	Comprehensive community support services, per 15 minutes	74,440	$80	$5.7M
H0004	Behavioral health counseling and therapy, per 15 minutes	53,190	$80	$4.4M
H2000	Comprehensive multidisciplinary evaluation	44,460	$80	$3.7M
T1016	Case management, each 15 minutes	37,900	$60	$2.2M
H2011	Crisis intervention service, per 15 minutes	17,180	$130	$2.2M
S9484	Crisis intervention mental health services, per hour	6,930	$170	$1.2M
H2010	Comprehensive medication services, per 15 minutes	35,500	$30	$922.9K
T1502	Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional, per visit	17,110	$20	$256.6K
H0034	Medication training and support, per 15 minutes	9,750	$20	$224.2K

Showing 1–10 of 18

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Illinois Distribution

Heritage Behavioral Health Center Inc. — 6 of 18 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Illinois

Full comparison — all codes billed, vs. Illinois median

18 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0039	Assertive community treatment, face-to-face, per 15 minutes	4	50	14,910	$140	$4.1M
H2015	Comprehensive community support services, per 15 minutes	22	430	3,260	$80	$1.3M
S9484	Crisis intervention mental health services, per hour	14	80	1,600	$260	$972.5K
H0004	Behavioral health counseling and therapy, per 15 minutes	36	800	2,480	$90	$962.2K
H2011	Crisis intervention service, per 15 minutes	16	160	1,060	$180	$959.9K
H2000	Comprehensive multidisciplinary evaluation	12	420	1,450	$100	$631.8K
H0005	Alcohol and/or drug services; group counseling by a clinician	181	240	2,810	$60	$602.7K
T1016	Case management, each 15 minutes	23	470	1,830	$60	$475.9K
H0020	Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)	49	50	1,770	$60	$223.4K
H0034	Medication training and support, per 15 minutes	16	110	1,030	$40	$179.2K

Showing 1–10 of 18

Nearby Providers

Other providers in the same ZIP code as Heritage Behavioral Health Center Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Macon County Mental Health Board	IL	Case Management Agency	$0	$3.4M

Heritage Behavioral Health Center Inc. — Billing Profile & Reimbursement Data

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Heritage Behavioral Health Center 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

Nearby Providers

Frequently Asked Questions

References