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

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

Counseling Service Of Addison County (NPI 1730218868)

Field	Value
Entity Type	Organization
Organization	Counseling Service Of Addison County
Address	89 Main St
City	Middlebury
State	VT
ZIP	05753
Taxonomy	Developmental Disabilities Clinic/Center
NPI Enumerated	March 5, 2007

Payer Source	Total Paid
Medicaid	$59.6M
Medicare	$0

Key Findings

This provider is effectively a single-payer Medicaid operation: there is no Medicare billing on file and total Medicaid revenue is $59.6M, indicating that virtually all billed and paid activity for COUNSELING SERVICE OF ADDISON COUNTY flows through Medicaid rather than Medicare. The absence of Medicare revenue makes Medicaid the sole material payer for financial analysis and network positioning.

Revenue is extremely concentrated in a very small set of Medicaid codes: the precomputed top-3 Medicaid codes account for 100.0% of this provider's total Medicaid revenue, with 99199 generating $45.4M (76.1%) and H2022 generating $14.3M (23.9%) of Medicaid revenue. The third of the top three codes (H2025) is included in the top-3 mix but shows $0 revenue despite high claim volume, so the monetary exposure is essentially in 99199 and H2022.

The code mix and descriptions point to a developmental-disabilities-focused community services operation: 99199 (other medicine services or procedures) is the single largest revenue driver, and H2022 (Community-based wrap-around services, per diem) is the second-largest. Together these suggest the provider is billing for a mix of wrap-around community supports and catch-all ‘other’ service entries rather than standard physician fee-for-service office evaluation and management codes, consistent with a Developmental Disabilities Clinic/Center taxonomy.

Competitive standing on the largest revenue line is modest: 99199 (the $45.4M driver) ranks #8 of 16 providers in-state and sits at about the middle of the state distribution (roughly the 53rd percentile), which indicates the provider is a typical—neither dominant nor marginal—state participant for that code despite it being the primary revenue source.

H2022 shows typical to modest state volume for a wrap-around per diem payer line, ranking #9 of 14 providers (about the 38th percentile) while still representing $14.3M and 23.9% of this provider’s Medicaid revenue. In contrast, H2025 (ongoing support to maintain employment) is an outlier by activity volume: it ranks #1 of 20 providers in-state (100th percentile) with 30.7K claims, which the data labels as notably above typical state volume even though it shows $0 revenue. This combination indicates unusually high service activity recorded for employment support but not captured as paid Medicaid revenue.

Multiple commonly used Medicaid service codes show substantial claim counts but report $0 avg paid/claim (examples in the dataset include T1016 with 35.7K claims, T2021 with 27.6K claims, and S5150 with 16.7K claims). That pattern—high claim volume paired with $0 reported paid—is consistent with services that may be recorded for encounter or program-reporting purposes, bundled/waiver payment structures, or non-fee-for-service reimbursement mechanisms rather than straightforward per-claim Medicaid payments. Analysts should treat these as utilization indicators rather than fee-for-service revenue drivers.

The provider has an established tenure in the billing system, with an NPI enumerated on 2007-03-05 (~19 years ago), which supports the interpretation that these code and payment patterns are the result of long-running service models and local payer arrangements rather than a newly formed specialty entrant. The longevity reinforces that the concentrated revenue mix is likely stable and operationally embedded.

Given the concentrated revenue exposure—99199 at 76.1% and H2022 at 23.9% of Medicaid revenue—policy, audit, or reimbursement changes affecting either of those codes would have an outsized impact on total Medicaid receipts. The presence of very high-volume, $0-paid claim lines (notably H2025 at 30.7K claims with $0 paid and ranked as notably above typical state volume) also creates areas where documentation, encounter reporting, or payment methodology shifts could materially change reported utilization metrics even if direct paid revenue does not move.

Medicaid: Complete Services Breakdown

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

9 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	8,310	$5,460	$45.4M
H2022	Community-based wrap-around services, per diem	7,220	$1,970	$14.3M
H2025	Ongoing support to maintain employment, per 15 minutes	30,700	$0	$0
S5150	Unskilled respite care, not hospice; per 15 minutes	16,690	$0	$0
T1016	Case management, each 15 minutes	35,740	$0	$0
S5135	Companion care, adult (e.g., iadl/adl); per 15 minutes	6,480	$0	$0
S5140	Foster care, adult; per diem	2,760	$0	$0
S5151	Unskilled respite care, not hospice; per diem	5,440	$0	$0
T2021	Day habilitation, waiver; per 15 minutes	27,600	$0	$0

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Vermont Distribution

Counseling Service Of Addison County — 0 of 2 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. Vermont median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	8	20	6,570	$6,270	$59.7M
H2022	Community-based wrap-around services, per diem	9	10	18,970	$620	$35.6M
T1016	Case management, each 15 minutes	8	40	3,900	$1	$31.1K
T2021	Day habilitation, waiver; per 15 minutes	8	10	28,170	$1	$210
H2025	Ongoing support to maintain employment, per 15 minutes	1	20	3,440	$0	$0
S5150	Unskilled respite care, not hospice; per 15 minutes	8	10	27,240	$0	$0
S5135	Companion care, adult (e.g., iadl/adl); per 15 minutes	3	10	8,410	$0	$0
S5140	Foster care, adult; per diem	10	10	60,820	$0	$0
S5151	Unskilled respite care, not hospice; per diem	8	10	8,650	$0	$0

Nearby Providers

Other providers in the same ZIP code as Counseling Service Of Addison County, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Specialized Community Care, Inc	VT	Community/Behavioral Health Agency	$0	$60.9M
Counseling Service Of Addison County, Inc	VT	Clinic/Center	$0	$22.1M
Middlebury Pediatric Dentistry, PLLC	VT	Pediatric Dentistry	$0	$2.9M
Rainbow Pediatrics	VT	Pediatric Adolescent Medicine Physician	$0	$1.8M
Middlebury Volunteer Ambulance Association, Inc	VT	Ambulance	$508.9K	$1.3M
Porter Hospital, Inc	VT	Family Medicine Physician	$0	$1.3M
Brian Collins	VT	Pediatric Dentistry	$0	$606.8K
Middlebury Family Health	VT	Health Maintenance Organization	$0	$547.3K
Amy Gregory	VT	Ophthalmology Physician	$306.6K	$0
Elizabeth Keathley	VT	Clinical Psychologist	$0	$303.3K

Counseling Service Of Addison County — Billing Profile & Reimbursement Data

Sign up for Counseling Service Of Addison County — Billing Profile & Reimbursement Data policy alerts

Counseling Service Of Addison County — Billing Profile & Reimbursement Data

Sign up for Counseling Service Of Addison County — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References