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

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

Frontier Health (NPI 1720147408)

Field	Value
Entity Type	Organization
Organization	Frontier Health
Address	1167 Spratlin Park Dr
City	Gray
State	TN
ZIP	37615
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	December 8, 2006

Payer Source	Total Paid
Medicaid	$105.1M
Medicare	$0

Key Findings

FRONTIER HEALTH is effectively a single-payer Medicaid operator: there is no Medicare billing on file and the provider reports $105.1M in lifetime Medicaid revenue, with an NPI enumerated on 2006-12-08 (~20 years ago) indicating long tenure in the market. This combination — long-established enrollment and concentrated Medicaid revenue — signals the organization has been operating as a Medicaid-focused behavioral health provider for many years.

Revenue is highly concentrated in a small set of Medicaid codes: the precomputed top three codes (S0280, 90834, H0043) account for 68.4% of the provider’s total Medicaid revenue. Those top codes are S0280 $41.8M (39.8%), 90834 $15.6M (14.9%), and H0043 $14.4M (13.7%), indicating that a few program lines drive the majority of dollars.

The code mix points to an integrated community behavioral health model combining care coordination, high-volume outpatient psychotherapy, and housing supports: S0280 (medical home program) is the single largest revenue driver, 90834 (38–52 minute psychotherapy) is the second-largest, and H0043 (supported housing, per diem) is third. Supporting codes such as H0006 (case management), H0037 (community psychiatric supportive treatment), and H2017 (psychosocial rehabilitation) further indicate a blend of clinical therapy and non-clinical social supports and per-diem services.

FRONTIER HEALTH is a dominant state-level volume performer on several core behavioral-health services. 90834 ranks #3 of 360 providers in-state (99th percentile; extreme outlier) and H0043 ranks #2 of 20 (95th percentile), while S0280 ranks #7 of 40 (85th percentile) — together these ranks show unusually large psychotherapy and housing program scale relative to most in-state peers. Additional high ranks for evaluation and E/M codes (for example 99213 is #26 of 4050, 99th percentile, and 99212 is #1 of 1170, 100th percentile) reinforce that this provider operates at a substantially higher volume than peers across multiple service lines.

The provider reports extraordinarily high psychotherapy volume across multiple CPTs, signaling an outpatient therapy-dominant clinical workload: 90834 has 273.9K claims, 90832 has 70.6K claims, 90837 has 22.7K claims, and 90847 has 41.2K claims. Many of these psychotherapy and evaluation codes are labeled as “extreme outlier” or “notably above typical state volume” in their rank descriptors (for example 90834 is an extreme outlier at the 99th percentile and 90791 is an extreme outlier at the 98th percentile), indicating the provider’s clinical throughput is far above typical in-state levels.

Per-claim payment patterns show a mix of low-dollar high-volume psychotherapy payments and materially higher per-diem/crisis payments: average paid/claim for 90834 is $57 while S0280 averages $153/claim, H0043 $69/claim, and crisis/residential items such as H2011 average $748/claim and T2033 average $269/claim. This split implies the revenue base combines large-volume outpatient therapy encounters with a smaller number of higher-dollar per-diem or crisis interventions that materially contribute to total revenue.

Several specialized services appear to be concentrated and potentially differentiated in-state: FRONTIER HEALTH is the highest-ranked reporter for codes including H0006 (case management, #1 of 7, 100th percentile), H0023 (behavioral health outreach, #1 of 3, 100th percentile), and G0155 (clinical social worker in home health/hospice settings, #1 of 13, 100th percentile). These #1 ranks suggest the provider may operate unique or intensive outreach, case management, or in-home behavioral health programs relative to most peers in Tennessee.

The heavy dependence on a small set of codes creates exposure to policy or rate changes for those services and operational implications for workforce and care delivery. With 68.4% of Medicaid revenue tied to S0280, 90834, and H0043 and very high claim volumes for psychotherapy codes, any changes to payment, prior authorization, or provider-capacity constraints for those service types would likely have an outsized impact on the provider’s overall Medicaid revenue and utilization profile.

Medicaid: Complete Services Breakdown

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

56 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S0280	Medical home program, comprehensive care coordination and planning, initial plan	272,990	$150	$41.8M
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…	273,930	$60	$15.6M
H0043	Supported housing, per diem	208,850	$70	$14.4M
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…	127,730	$40	$5.1M
90847	A provider meets with the patient’s family with the patient present to counsel the family on the psychological issues affecting the patient and the family. The provider supplies psychotherapy to the…	41,210	$70	$2.9M
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…	70,570	$40	$2.7M
H2017	Psychosocial rehabilitation services, per 15 minutes	33,360	$80	$2.6M
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	31,500	$80	$2.6M
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…	53,960	$50	$2.5M
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…	22,710	$90	$2M

Showing 1–10 of 56

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Frontier Health — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

56 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2023	Targeted case management; per month	14	10	11,790	$410	$75.3M
T2033	Residential care, not otherwise specified (nos), waiver; per diem	46	100	4,520	$320	$31.6M
S0280	Medical home program, comprehensive care coordination and planning, initial plan	7	40	22,180	$140	$21.3M
H0037	Community psychiatric supportive treatment program, per diem	8	20	20,260	$150	$19.4M
H0043	Supported housing, per diem	2	20	69,350	$180	$18.6M
H0036	Community psychiatric supportive treatment, face-to-face, per 15 minutes	6	10	2,040	$430	$7.7M
H2022	Community-based wrap-around services, per diem	3	10	6,900	$840	$6.8M
T2022	Case management, per month	17	20	1,370	$240	$5.5M
T2021	Day habilitation, waiver; per 15 minutes	81	100	3,920	$80	$3.4M
H2017	Psychosocial rehabilitation services, per 15 minutes	5	20	11,380	$70	$1.9M

Showing 1–10 of 56

Related Providers

Other providers that share a Tax Identification Number (TIN) with Frontier Health, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sarah Hayes	TN	Psychiatric/Mental Health Nurse Practitioner	$128.7K	$0
Christopher Rudd	TN	Family Nurse Practitioner	$16K	$0
Rebecca Greenway	TN	Clinical Social Worker	$8.3K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
State Of Franklin Healthcare Associates PLLC	TN	Internal Medicine Physician	$0	$23.2M
A Heavenly Sonshine Service Co	TN	In Home Supportive Care Agency	$0	$6.3M
Breakthrough Medical Clinic Of Tennessee Inc	TN	Substance Use Disorder Rehabilitation Clinic/Center	$0	$3.8M
Enhanced Support Services	TN	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$3.8M
East Tennessee Healthcare Holdings Inc	TN	Substance Use Disorder Rehabilitation Clinic/Center	$163.7K	$3.3M
Mountain Wings; LLC	TN	In Home Supportive Care Agency	$0	$3M
Matthew Grimm	TN	Family Nurse Practitioner	$301.9K	$0
Fay Bembry	TN	Psychiatric/Mental Health Nurse Practitioner	$207K	$57.1K
Stuart Leicht	TN	Dermatology Physician	$178.8K	$710
Tiffany Yandell	TN	Family Nurse Practitioner	$115.4K	$0

Frontier Health — Billing Profile & Reimbursement Data

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Frontier Health — 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