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.

Mountaineer Behavioral Health (NPI 1780135863)

Field	Value
Entity Type	Organization
Organization	Mountaineer Behavioral Health
Address	3094 Charles Town Road
City	Kearneysville
State	WV
ZIP	25430
Taxonomy	Substance Abuse Rehabilitation Facility
NPI Enumerated	October 24, 2016

Payer Source	Total Paid
Medicaid	$20.5M
Medicare	$0

Key Findings

MOUNTAINEER BEHAVIORAL HEALTH is effectively a Medicaid-focused Substance Abuse Rehabilitation Facility: total Medicaid revenue on file is $20.5M while there is no Medicare billing on file, indicating an operational footprint built around state Medicaid programs rather than Medicare fee-for-service. Its NPI was enumerated on 2016-10-24 (~10 years ago), so the entity has roughly a decade of billing history to the state Medicaid system.

Revenue is highly concentrated in a handful of service lines: the precomputed top 3 Medicaid codes account for 96.6% of the provider's Medicaid revenue, with H2036 representing $15M (73.5% of Medicaid revenue), H0004 $3.7M (18.0%), and 99213 $1M (5.1%). This concentration means the provider’s financial performance is closely tied to utilization and reimbursement for those specific codes.

The code mix signals a core business model centered on structured substance-use treatment plus routine outpatient care: H2036 (Alcohol and/or other drug treatment program, per diem) as the largest revenue driver suggests residential or per-diem program services are the primary delivery mechanism, while H0004 (behavioral health counseling and therapy, per 15 minutes) shows heavy volume of counseling sessions and 99213 shows routine office-based E/M activity integrated into care pathways.

From a competitive-standing perspective within West Virginia, the provider is a mid-to-upper-tier participant on its top codes rather than a statewide dominant provider. H2036 ranks #6 of 35 providers in-state (85th percentile) and H0004 ranks #22 of 166 providers (87th percentile), both described as typical, unremarkable volume for those codes, while 99213 ranks #120 of 1273 providers (91st percentile), indicating strong placement relative to large numbers of outpatient E/M billers but still within a common utilization pattern.

There are notable code-level deviations that merit attention despite small absolute revenue impact: the presumptive drug-testing code 80306 generated $88.9K (0.4% of Medicaid revenue) but ranks #2 of 24 providers in-state (96th percentile) and is labeled notably above typical state volume. That suggests this provider either screens frequently as part of its treatment protocols or concentrates testing differently than most peers.

Operational risk is concentrated: because H2036, H0004, and 99213 together make up 96.6% of Medicaid revenue, policy, rate, or utilization changes that affect any of these three codes could disproportionately affect total revenue. Analysts and contract negotiators should flag those codes when assessing reimbursement vulnerability or designing value-based arrangements.

Service mix details support care-delivery breadth within behavioral health: beyond the three revenue leaders, the provider bills a range of psychotherapy, assessment, case-management, and telehealth-originating-site fees (examples include H0031, 90837, T1017, Q3014) but each contributes only small shares of revenue. These ancillary codes indicate the organization offers clinical assessment, individual and group therapy, targeted case management, and some telehealth services, consistent with a multi-modal substance-use treatment program.

Given the absence of Medicare billing on file and the Medicaid-centric revenue base of $20.5M, strategic initiatives that expand Medicaid volume or diversify payer mix (if desired) would materially change the facility’s financial profile. For current benchmarking and readiness assessments, focus on state Medicaid policy, reimbursement trends for H2036 and H0004, and the provider’s high-volume E/M utilization represented by 99213.

Medicaid: Complete Services Breakdown

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

23 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2036	Alcohol and/or other drug treatment program, per diem	72,990	$210	$15M
H0004	Behavioral health counseling and therapy, per 15 minutes	42,840	$90	$3.7M
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…	19,300	$50	$1M
H0031	Mental health assessment, by non-physician	780	$170	$133.6K
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…	1,580	$80	$118.1K
80306	The lab analyst performs presumptive drug test(s) by any method that the analyst can read by instrument–assisted direct optical observation, often utilizing immunoassay, to screen for any number of…	8,080	$10	$88.9K
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…	850	$90	$73.6K
80305	The lab analyst performs presumptive drug test(s) by any method that the analyst can read by direct optical observation only, without instrument assistance, to screen for any number of drug classes…	5,900	$10	$59K
T1017	Targeted case management, each 15 minutes	1,460	$30	$42.3K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	1,020	$30	$31.7K

Showing 1–10 of 23

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

Mountaineer Behavioral Health — 1 of 23 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

23 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2036	Alcohol and/or other drug treatment program, per diem	6	40	29,190	$210	$7.8M
H0038	Self‑help/peer services, per 15 minutes	55	60	3,310	$110	$1.6M
H0004	Behavioral health counseling and therapy, per 15 minutes	22	170	8,500	$80	$1.5M
H0031	Mental health assessment, by non-physician	51	120	620	$160	$312.6K
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…	120	1,270	1,240	$30	$245K
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…	401	1,030	890	$50	$221K
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…	150	310	740	$80	$178.2K
H0032	Mental health service plan development by non-physician	19	60	280	$80	$141.9K
Q3014	Telehealth originating site facility fee	44	80	580	$20	$104.1K
99204	The provider sees a new 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 provider…	124	340	140	$90	$97.5K

Showing 1–10 of 23

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Stonebrook, Inc	WV	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$8.6M
Renovo Center LLC	WV	Community/Behavioral Health Agency	$0	$2M
Ryneal Fire Company #1	WV	Ambulance	$9.4K	$1.6M
Renovo Center LLC	WV	Community/Behavioral Health Agency	$0	$1.5M
Gateway Home Care, LLC	WV	Durable Medical Equipment & Medical Supplies	$0	$1.1M
Jan Nieves	WV	Psychiatric/Mental Health Nurse Practitioner	$63.4K	$0
Terrence Reidy	WV	Internal Medicine Physician	$13.4K	$0

Mountaineer Behavioral Health — Billing Profile & Reimbursement Data

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Mountaineer Behavioral 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

Nearby Providers

Frequently Asked Questions

References