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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Potomac Highlands Guild (NPI 1720273170)

Field	Value
Entity Type	Organization
Organization	Potomac Highlands Guild
Address	6 Park St
City	Petersburg
State	WV
ZIP	26847
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	September 10, 2007

Payer Source	Total Paid
Medicaid	$38.9M
Medicare	$0

Key Findings

POTOMAC HIGHLANDS GUILD is effectively a single-payer Medicaid provider with no Medicare billing on file; total Medicaid revenue is reported at $38.9M and there is no recorded Medicare revenue, so all observed clinical and operational activity in claims data is driven by Medicaid-funded services. This concentrated payer mix implies the organization’s financial performance and service priorities are closely tied to state Medicaid policy and reimbursement rates.

Revenue concentration is highly focused: the top 3 Medicaid codes by revenue account for 88.5% of this provider's total Medicaid revenue. In particular, S5125 alone represents $27.5M (70.8% of Medicaid revenue), indicating that attendant care services are the primary revenue driver for the organization and its operating model is centered on intensive attendant care delivery.

The code mix—dominated by S5125 (attendant care services), along with meaningful contributions from T1005 (respite care services) and T2021 (day habilitation, waiver)—signals that this provider functions primarily as a community/behavioral health agency focusing on hands-on personal support, respite for caregivers, and habilitative day services. High volumes of per-15-minute service codes suggest a service model built around frequent, short-interval direct care encounters rather than episodic procedures or facility-based stays.

Competitive standing within the state is mixed but generally strong for several service lines: S5125 ranks #5 of 43 providers in-state (90th percentile), reflecting a top-quartile position for attendant care volume and confirming the provider is a sizeable, but not the largest, supplier of that service. T1005 ranks #8 of 29 providers (75th percentile) and T2021 ranks #7 of 57 providers (89th percentile), both indicating typical to above-typical volumes for those service types and reinforcing that this organization is a prominent regional player in waiver and home/community care services.

There are notable code-level concentration and relative specialty signals beyond the top code: T1016 (case management, each 15 minutes) generates $866.1K and ranks #5 of 96 providers in-state (96th percentile), described as notably above typical state volume; this suggests the provider maintains a strong case management footprint in addition to hands-on attendant care, which may support care coordination for high-utilizer populations. Other codes such as A0160 (non-emergency transportation: per mile) and A0120 (mini-bus/transportation) show large claim counts and state percentile placements (86th and 92th percentiles respectively), indicating transportation services are a meaningful ancillary operation.

The provider’s NPI has been enumerated since 2007-09-10 (~19 years ago), indicating long tenure in the market. That longevity, combined with the concentration in recurring Medicaid waiver and attendant care codes, is consistent with an established community/behavioral health agency that has developed sustained relationships with state Medicaid programs and local care networks.

Several service lines show typical but high-volume activity rather than extreme outlier behavior: multiple codes are labeled as "typical, unremarkable volume for this code" despite large absolute revenues (for example, S5125 and T1005), which suggests the provider’s scale aligns with established in-state patterns for community-based attendant and respite care rather than anomalous billing patterns. At the same time, the presence of a code described as "notably above typical state volume" (T1016) points to specific areas of operational emphasis that exceed peer norms and may represent a competitive advantage in care coordination.

Medicaid: Complete Services Breakdown

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

10 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S5125	Attendant care services; per 15 minutes	86,060	$320	$27.5M
T1005	Respite care services, up to 15 minutes	4,240	$1,140	$4.8M
T2021	Day habilitation, waiver; per 15 minutes	38,630	$50	$2M
A0160	Non-emergency transportation: per mile - case worker or social worker	14,110	$100	$1.4M
G9002	Coordinated care fee, maintenance rate	6,210	$200	$1.2M
T1016	Case management, each 15 minutes	25,470	$30	$866.1K
A0120	Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems	22,920	$20	$412.5K
T1002	Rn services, up to 15 minutes	9,100	$30	$291.2K
T1003	Lpn/lvn services, up to 15 minutes	4,780	$40	$181.4K
T2024	Service assessment/plan of care development, waiver	1,750	$60	$99.8K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Potomac Highlands Guild — 1 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

10 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5125	Attendant care services; per 15 minutes	5	40	14,820	$750	$30.5M
T2021	Day habilitation, waiver; per 15 minutes	7	60	6,490	$120	$2.2M
T1005	Respite care services, up to 15 minutes	8	30	2,980	$250	$1.5M
G9002	Coordinated care fee, maintenance rate	30	120	2,950	$150	$901.9K
T1003	Lpn/lvn services, up to 15 minutes	11	30	2,070	$90	$522.7K
T1016	Case management, each 15 minutes	5	100	2,790	$90	$496.2K
A0160	Non-emergency transportation: per mile - case worker or social worker	16	110	2,030	$50	$278.8K
T1002	Rn services, up to 15 minutes	20	150	1,980	$40	$232.6K
A0120	Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems	5	50	1,390	$30	$183.1K
T2024	Service assessment/plan of care development, waiver	15	50	760	$50	$95.5K

Nearby Providers

Other providers in the same ZIP code as Potomac Highlands Guild, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Potomac Highlands Mental Health Guild, Inc.	WV	Community/Behavioral Health Agency	$0	$17.1M
Grant Memorial Hospital	WV	Critical Access Hospital	$0	$13M
E. A. Hawse Health Center, Inc.	WV	Federally Qualified Health Center (FQHC)	$0	$7.8M
Commission On Aging Family Services	WV	Community Based Hospice Care Agency	$0	$3.3M
Grant Memorial Hospital Inc	WV	Critical Access Hospital	$0	$2.4M
John L Hahn Md Inc	WV	Obstetrics & Gynecology Physician	$0	$1.4M
County Of Grant	WV	Land Ambulance	$271.5K	$998.9K
Stephen Thompson	WV	Internal Medicine Physician	$99.4K	$6.8K
Benjamin Leslie	WV	Internal Medicine Physician	$87.8K	$7.5K
Caroline Armstrong	WV	Internal Medicine Physician	$75K	$10.1K

Potomac Highlands Guild — Billing Profile & Reimbursement Data

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Potomac Highlands Guild — 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