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

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

South Middlesex Opportunity Council Inc (NPI 1740336858)

South Middlesex Opportunity Council Inc is a community/behavioral health agency provider located in Framingham, Massachusetts. This profile covers 0 Medicare and 15 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	South Middlesex Opportunity Council Inc
Address	7 Bishop St
City	Framingham
State	MA
ZIP	01702
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	January 25, 2007

Payer Source	Total Paid
Medicaid	$37.4M
Medicare	$0

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

15 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	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	5,200	$3,390	$17.6M
H2016	Comprehensive community support services, per diem	115,100	$70	$8.4M
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…	111,070	$60	$7.1M
H2019	Therapeutic behavioral services, per 15 minutes	10,860	$130	$1.4M
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…	21,980	$60	$1.2M
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…	3,830	$90	$340.4K
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	11,250	$30	$337.5K
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…	10,400	$30	$260.1K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	2,040	$120	$240.2K
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…	5,480	$40	$191.9K

Showing 1–10 of 15

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

South Middlesex Opportunity Council Inc — 2 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

15 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	38	80	5,200	$370	$8.4M
H2019	Therapeutic behavioral services, per 15 minutes	92	290	3,680	$150	$2.9M
H2016	Comprehensive community support services, per diem	10	80	4,550	$30	$1.6M
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…	27	1,620	580	$80	$599.6K
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…	418	1,020	460	$100	$293.7K
90887	In this service, the provider interprets or explains the results of psychiatric exams, medical exams, other procedures, or information about the patient’s care to the patient’s family members or…	129	230	470	$60	$221.1K
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…	113	5,040	200	$70	$209.5K
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…	434	5,300	230	$60	$164.5K
90882	In this service, the provider works with outside agencies, employers, or other healthcare providers regarding the patient’s physical environment to help manage a psychiatric patient’s medical care.	75	250	470	$50	$162.5K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	66	600	90	$110	$106.8K

Showing 1–10 of 15

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Commonwealth Of Massachusetts	MA	Case Management Agency	$0	$350.2M
Vhs Acquisition Subsidiary Number 9 Inc	MA	General Acute Care Hospital	$0	$58.9M
New England Family Dental PC	MA	Point of Service	$0	$14.6M
Justice Resource Institute, Inc.	MA	Developmentally Disabled Services Day Training Agency	$0	$14.2M
Advanced Home Care Services LLC	MA	Home Health Agency	$0	$12.4M
New Horizons Medical, Inc.	MA	Addiction (Substance Use Disorder) Counselor	$0	$11.7M
Robert Johnston	MA	Psychiatry Physician	$10.9K	$11M
Hdc Care Solutions, LLC	MA	Nurse Practitioner	$0	$8M
Alec H. Jaret, Dmd, PC	MA	Dentist	$0	$7.3M
New England Aftercare Ministries, Inc.	MA	Substance Abuse Rehabilitation Facility	$0	$6.4M

South Middlesex Opportunity Council Inc — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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Frequently Asked Questions

References