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

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

Pathways Of Tennessee, Inc. (NPI 1780789115)

Pathways Of Tennessee, Inc. is a psychiatric hospital provider located in Jackson, Tennessee. This profile covers 0 Medicare and 24 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	Pathways Of Tennessee, Inc.
Address	238 Summar Dr
City	Jackson
State	TN
ZIP	38301
Taxonomy	Psychiatric Hospital
NPI Enumerated	September 13, 2006

Payer Source	Total Paid
Medicaid	$3.3M
Medicare	$0

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

24 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S0280	Medical home program, comprehensive care coordination and planning, initial plan	16,310	$110	$1.9M
S9480	Intensive outpatient psychiatric services, per diem	8,970	$90	$806.9K
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…	9,660	$40	$367K
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…	6,520	$30	$169.5K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	680	$60	$42.3K
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…	990	$30	$25.8K
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,…	580	$20	$12.2K
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…	340	$30	$8.4K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	180	$30	$5.9K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	60	$30	$1.6K

Showing 1–10 of 24

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Pathways Of Tennessee, Inc. — 0 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

24 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S0280	Medical home program, comprehensive care coordination and planning, initial plan	21	40	22,180	$140	$21.3M
S9480	Intensive outpatient psychiatric services, per diem	2	10	3,210	$120	$524.4K
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…	25	360	350	$50	$414.4K
S9485	Crisis intervention mental health services, per diem	8	20	1,410	$60	$291.9K
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…	103	300	480	$30	$221.2K
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…	2,254	3,760	610	$40	$202.3K
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…	568	4,050	620	$30	$183.9K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	64	310	110	$70	$142.8K
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	146	200	130	$60	$86.5K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	683	840	440	$20	$73K

Showing 1–10 of 24

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pathways Of Tennessee, Inc.	TN	Clinic/Center	$0	$30.6M
Twana Miller	TN	Clinical Social Worker	$52.4K	$603K
David Helm	TN	Psychiatry Physician	$74.5K	$0
Indria Clay	MN	Clinical Social Worker	$57.8K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Jackson Madison County General Hospital	TN	General Acute Care Hospital	$0	$46.6M
Emergency Medical Care Facilities PC	TN	Emergency Medicine Physician	$0	$19.7M
A Plus Care Solutions Incorporated	TN	In Home Supportive Care Agency	$0	$18.4M
Jackson-madison County General Hospital	TN	Land Ambulance	$5.1M	$13M
Mid-south Perinatal Associates PC	TN	Maternal & Fetal Medicine Physician	$0	$11.6M
West Tennessee Medical Group Inc	TN	Internal Medicine Physician	$0	$8.2M
Wt University Medical Associates Inc	TN	Family Medicine Physician	$0	$7.5M
Jackson-madison County General Hospital	TN	Community/Retail Pharmacy	$0	$7.4M
Shavetta Conner	TN	Public Health & General Preventive Medicine Physician	$8.1K	$4.9M
West Tennessee Healthcare Hospitalists Inc	TN	Hospitalist Physician	$0	$4.3M

Pathways Of Tennessee, Inc. — Billing Profile & Reimbursement Data

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Pathways Of Tennessee, 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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