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.

Northwestern Counseling & Support Services (NPI 1780708263)

Field	Value
Entity Type	Organization
Organization	Northwestern Counseling & Support Services
Address	107 Fisher Pond Road
City	Saint Albans
State	VT
ZIP	05478
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	March 19, 2007

Payer Source	Total Paid
Medicaid	$129.9M
Medicare	$0

Key Findings

This provider is effectively single‑payer in practice: there is no Medicare billing on file and all reported professional revenue is Medicaid-based, with total Medicaid revenue of $129.9M. The absence of Medicare claims suggests the organization’s services and contracts are primarily routed through state Medicaid programs rather than fee‑for‑service Medicare channels.

Revenue is extremely concentrated in a very small number of Medicaid codes: the precomputed top 3 Medicaid codes by revenue account for 99.8% of this provider’s total Medicaid revenue. The two dominant line items are 99199 ($90.9M, 70.0% of Medicaid revenue) and H2022 ($38.5M, 29.6% of Medicaid revenue), with 90834 contributing only $272.8K (0.2%).

The code mix and paid amounts indicate a dual operating model: high‑volume, low‑unit‑price wraparound services and a smaller number of very high‑paid unspecified procedure entries. H2022 (Community‑based wrap‑around services, per diem) shows 291.6K claims at $132 avg paid/claim, consistent with per‑diem day‑level billing across large caseloads. By contrast, 99199 (other medicine services) has 14.5K claims but a markedly higher $6259 avg paid/claim, indicating a set of high‑value, non‑specific procedure billings that drive the majority of revenue.

Competitive standing varies by code: the provider is a clear statewide leader for H2022, ranking #1 of 14 providers in‑state (100th percentile) and described as notably above typical state volume for that code, which supports a dominant position in Medicaid wraparound delivery. For 99199 the provider ranks #5 of 16 in‑state (73th percentile) and is characterized as typical/unremarkable volume, so the large dollar total for 99199 is impactful to revenue but not an extreme outlier in state market share. The psychotherapy code 90834 ranks #20 of 165 providers in‑state (88th percentile) but contributes only $272.8K (0.2%), indicating modest clinical psychotherapy billing relative to overall revenue.

Operational reporting patterns show many waiver, habilitation, and support service codes with high claim counts but $0 avg paid/claim (for example T1016, T2021, H2025 and several others). These zero‑paid entries (T1016: 99.2K claims; T2021: 69.6K claims; H2025: 27.2K claims) suggest extensive encounter or encounter‑level reporting that may be reconciled under bundled or capitated payment models rather than line‑item paid claims, and they materially increase activity volume even though they do not contribute recorded Medicaid dollars in this dataset.

The mix of an extremely high‑value, non‑specific procedure code (99199) and very large per‑diem wraparound volume (H2022) has important business implications: the organization’s financial performance is highly dependent on reimbursement for those two code families, making revenue sensitive to changes in how state Medicaid pays for unspecified procedures or per‑diem wraparound services. Given that the top two codes together account for the bulk of revenue, contract negotiations or policy changes affecting H2022 or allowable uses of 99199 would disproportionately affect this provider’s Medicaid revenue.

The provider is an established entity, with its NPI enumerated on 2007-03-19 (~19 years ago), indicating long tenure in the market. That longevity, combined with the #1 statewide position on H2022, suggests entrenched operational capacity for community‑based wraparound services even as its dependency on a small number of revenue codes represents concentrated financial exposure.

Medicaid: Complete Services Breakdown

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

19 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.	14,520	$6,260	$90.9M
H2022	Community-based wrap-around services, per diem	291,550	$130	$38.5M
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…	3,170	$90	$272.8K
H2000	Comprehensive multidisciplinary evaluation	370	$590	$219.9K
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…	140	$20	$3K
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…	90	$1	$90
H2011	Crisis intervention service, per 15 minutes	1,260	$0	$0
H2015	Comprehensive community support services, per 15 minutes	90	$0	$0
H2023	Supported employment, per 15 minutes	910	$0	$0
H2025	Ongoing support to maintain employment, per 15 minutes	27,210	$0	$0

Showing 1–10 of 19

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

Northwestern Counseling & Support Services — 1 of 6 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

19 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.	5	20	6,570	$6,270	$59.7M
H2022	Community-based wrap-around services, per diem	1	10	18,970	$620	$35.6M
H2015	Comprehensive community support services, per 15 minutes	19	20	64,230	$90	$7.1M
T2025	Waiver services; not otherwise specified (nos)	3	10	1,270	$820	$2.1M
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…	260	320	680	$30	$146.1K
H2011	Crisis intervention service, per 15 minutes	12	20	1,680	$20	$96.2K
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…	20	170	360	$20	$35.9K
T1016	Case management, each 15 minutes	3	40	3,900	$1	$31.1K
H2000	Comprehensive multidisciplinary evaluation	8	20	50	$50	$24.3K
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…	66	110	260	$20	$19.5K

Showing 1–10 of 19

Nearby Providers

Other providers in the same ZIP code as Northwestern Counseling & Support Services, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Northwestern Counseling & Support Services Inc	VT	Community/Behavioral Health Agency	$0	$70.4M
Amcare Medical Systems, Inc.	VT	Land Ambulance	$576.2K	$2.2M
Baart Behavioral Health Services, Inc.	VT	Substance Use Disorder Rehabilitation Clinic/Center	$180.2K	$2.5M
Northwestern Medical Center, Inc.	VT	Pediatrics Physician	$0	$1.4M
Northwestern Medical Center, Inc.	VT	General Acute Care Hospital	$0	$1.1M
Remy Vallee Dmd Inc	VT	Dentist	$0	$1.1M
Calm Reflections Psychotherapy, LLC	VT	Clinical Social Worker	$0	$840.8K
Northwestern Medical Center, Inc.	VT	Urgent Care Clinic/Center	$0	$757.2K
Northern Valley Eyecare, Inc.	VT	Optometrist	$0	$703.1K
Michelle Pelkey	VT	Clinical Social Worker	$0	$550.9K

Northwestern Counseling & Support Services — Billing Profile & Reimbursement Data

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Northwestern Counseling & Support Services — 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