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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

Rising Hope Counseling, LLC (NPI 1780190967)

Field	Value
Entity Type	Organization
Organization	Rising Hope Counseling, LLC
Address	420 S Henry St
City	Pierre
State	SD
ZIP	57501
Taxonomy	Mental Health Counselor
NPI Enumerated	December 25, 2017

Payer Source	Total Paid
Medicaid	$4M
Medicare	$0

Key Findings

RISING HOPE COUNSELING is effectively a single-payer Medicaid practice: there is no Medicare billing on file and the provider reports $4M in lifetime Medicaid revenue. The absence of Medicare claims indicates the business’s revenue and utilization profile should be interpreted entirely in the context of Medicaid policy, reimbursement, and patient mix in South Dakota.

Revenue is highly concentrated in a small set of procedure codes: the precomputed top three Medicaid codes account for 90.5% of the provider’s total Medicaid revenue. This concentration means a few service lines—chiefly one psychotherapy code—dominate the practice’s financial performance and reimbursement risk profile.

Code-level concentration is extreme around long psychotherapy sessions: 90837 accounts for $3.1M revenue (79.0% of this provider's total Medicaid revenue), with 31K claims and a $101 avg paid/claim, and ranks #1 of 185 providers in-state (100th percentile; extreme outlier). This single code’s volume and share indicate the practice’s operations are primarily structured around prolonged individual psychotherapy encounters.

Supporting the psychotherapy focus, 90834 and 90791 are the next-largest drivers: 90834 produced $261.1K (6.6%) with 3.7K claims and $70 avg paid/claim and ranks #6 of 82 (94th percentile; notably above typical), while 90791 produced $193.7K (4.9%) with 2.2K claims and $90 avg paid/claim and ranks #6 of 68 (93th percentile; notably above typical). Together with 90837, these three codes form the clinical backbone (long and mid-length psychotherapy plus psychiatric evaluation) underlying most billing activity.

The code mix implies a service-line model centered on outpatient psychotherapy and intake assessments: dominant use of 90837 (long individual psychotherapy), paired with high counts of 90834 and 90791, points to a workflow emphasizing repeated, extended therapy sessions and substantial new-evaluation volume rather than diverse medical management. Ancillary E/M codes (99214, 99213) and H0046 appear in the mix but represent modest revenue shares and likely serve a secondary role in care delivery.

Despite the narrow code mix, the provider’s competitive standing is strong on key mental health measures statewide: ranking #1 of 185 for 90837 and top single-digit ranks for 90834 and 90791 show the practice is a major regional provider of psychotherapy services and a statistical outlier for long-session psychotherapy volume. For other codes (e.g., H0046, 90832, group therapy 90853, and routine E/M codes) the provider’s ranks fall in more typical percentiles, indicating the dominance is concentrated specifically in long individual psychotherapy.

Operational and business implications flow from the concentration: reliance on 90837 for 79.0% of Medicaid revenue creates exposure to policy, rate, or utilization changes affecting long psychotherapy reimbursements, and any payer-level auditing or coverage shifts for that code could materially affect revenue. Conversely, the high volume for that code may provide negotiating leverage or justify targeted staffing and scheduling models optimized for long-session psychotherapy.

The provider’s administrative tenure is established but not long-standing: the NPI was enumerated on 2017-12-25 (~9 years ago), which suggests the current billing profile and market presence developed over several years and should be evaluated in the context of regional behavioral-health capacity and referral patterns that produced the large 90837 caseload.

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
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…	31,030	$100	$3.1M
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…	3,730	$70	$261.1K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	2,150	$90	$193.7K
H0046	Mental health services, not otherwise specified	2,630	$60	$165.6K
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…	2,570	$50	$136.2K
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…	630	$50	$29.6K
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…	390	$70	$27.6K
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…	480	$40	$18.6K
90785	This add–on code represents increased work intensity of psychotherapy services that adds difficulty to delivery of service.	260	$0	$0

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

Rising Hope Counseling, LLC — 1 of 8 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	209	340	1,010	$100	$511K
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…	167	260	860	$80	$222.6K
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…	12	70	200	$80	$176.7K
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…	1	190	430	$90	$154.1K
H0046	Mental health services, not otherwise specified	3	10	3,200	$40	$131.9K
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…	14	30	330	$40	$104.9K
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…	6	80	200	$60	$53.9K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	6	70	60	$100	$51.4K
90785	This add–on code represents increased work intensity of psychotherapy services that adds difficulty to delivery of service.	2	10	230	$1	$560

Related Providers

Other providers that share a Tax Identification Number (TIN) with Rising Hope Counseling, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Blair Sedlacek	SD	Social Worker	$27.9K	$0
Tammy Vande Kamp	SD	Psychiatric/Mental Health Nurse Practitioner	$10.1K	$0

Nearby Providers

Other providers in the same ZIP code as Rising Hope Counseling, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Homecare Services Of South Dakota, Inc.	SD	Home Health Agency	$0	$20.1M
Resources For Human Development	SD	Case Management Agency	$0	$8.5M
Capital Area Counseling Service, Inc	SD	Clinical Social Worker	$0	$7.6M
Avera St Marys	SD	Multi-Specialty Clinic/Center	$0	$4.6M
Oahe, Inc.	SD	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$4.4M
Central Dakota Eyecare, LLP	SD	Optometrist	$0	$1.8M
Avera St Marys	SD	General Acute Care Hospital	$0	$1.7M
Delta Dental Of South Dakota Foundation	SD	Dental Clinic/Center	$0	$1.2M
Delta Dental Of South Dakota Foundation	SD	Dental Clinic/Center	$0	$1M
Delta Dental Of South Dakota Foundation	SD	Dental Clinic/Center	$0	$594K

Rising Hope Counseling, LLC — Billing Profile & Reimbursement Data

Sign up for Rising Hope Counseling, LLC — Billing Profile & Reimbursement Data policy alerts

Rising Hope Counseling, LLC — Billing Profile & Reimbursement Data

Sign up for Rising Hope Counseling, LLC — Billing Profile & Reimbursement Data policy alerts

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