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.

Tri-state Addiction Recovery Resources (NPI 1790242055)

Field	Value
Entity Type	Organization
Organization	Tri-state Addiction Recovery Resources
Address	537 Washington Ave
City	Huntington
State	WV
ZIP	25701
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	February 22, 2019

Payer Source	Total Paid
Medicaid	$29.6M
Medicare	$0

Key Findings

This provider is effectively a Medicaid-focused operation with no Medicare billing on file and $29.6M in lifetime Medicaid revenue; its NPI was enumerated 2019-02-22 (~7 years ago), indicating roughly seven years of claim activity concentrated in state Medicaid programs.

Revenue is highly concentrated: the precomputed top three Medicaid codes (H0038, H0004, J2315) together account for 86.8% of the provider’s Medicaid revenue, with H0038 contributing $15.5M (52.5%), H0004 contributing $8.4M (28.2%), and J2315 contributing $1.8M (6.1%).

The code mix points to a predominantly behavioral health and recovery services operation: heavy use of H0038 (self-help/peer services) and H0004 (behavioral health counseling and therapy) suggests programs built around peer recovery supports and counseling encounters, while J2315 (naltrexone depot injection) indicates active medication-assisted treatment capacity; sizable A0120 (non-emergency transportation) volume also shows investment in member transportation supports.

On statewide competitive standing this provider is dominant for several lines: H0038 ranks #1 of 57 providers in-state at the 100th percentile and is labeled an extreme outlier, and H0004 ranks #3 of 166 providers in-state at the 99th percentile and is also an extreme outlier, signaling a market-leading position in peer support and counseling services.

J2315 appears as a unique billing line locally: it generated $1.8M and is listed as #1 of 1 providers in-state with no state peer volume comparison available (0th percentile as reported), which suggests this provider is the sole reported statewide biller for naltrexone depot in the dataset rather than one among many peers.

Operational scale is evident in claim volumes: the provider submitted 105.7K H0038 claims and 114.4K H0004 claims, and 86.7K A0120 claims, reflecting very high throughput in non-physician behavioral services and transportation logistics, consistent with a large community/behavioral health agency footprint.

Clinical monitoring and ancillary services are prominent complements to treatment: 80306 (presumptive drug tests) appears with 10.8K claims, $118.5K revenue and ranks #1 of 24 providers in-state at the 100th percentile (extreme outlier), indicating routine, high-volume drug screening to support care pathways; meanwhile some E/M codes such as 99214 and 99213 are present but represent much smaller shares of revenue.

For payers and contracting teams, the concentration in a few high-volume codes (H0038, H0004, J2315 — 86.8% of Medicaid revenue) and the provider’s statewide dominance in peer support and counseling suggest that utilization management, rate-setting, and network decisions should prioritize monitoring these service lines and transportation (A0120), since changes to reimbursement or authorization policies for these codes would materially affect this provider’s Medicaid revenue stream.

Medicaid: Complete Services Breakdown

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

17 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0038	Self‑help/peer services, per 15 minutes	105,670	$150	$15.5M
H0004	Behavioral health counseling and therapy, per 15 minutes	114,390	$70	$8.4M
J2315	Injection, naltrexone, depot form, 1 mg	1,840	$980	$1.8M
A0120	Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems	86,680	$20	$1.6M
T1017	Targeted case management, each 15 minutes	9,100	$70	$655K
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…	8,200	$80	$639.6K
H0031	Mental health assessment, by non-physician	3,240	$160	$522.1K
H0032	Mental health service plan development by non-physician	2,880	$90	$256.5K
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…	10,780	$10	$118.5K
96372	A therapeutic, prophylactic, or diagnostic substance (a fluid, a drug, etc.) is injected via intramuscular or subcutaneous route into the patient's body. The procedure is performed by the physician…	3,700	$20	$70.3K

Showing 1–10 of 17

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

Tri-state Addiction Recovery Resources — 4 of 17 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

17 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J2315	Injection, naltrexone, depot form, 1 mg	1	10	1,840	$980	$1.8M
H0038	Self‑help/peer services, per 15 minutes	1	60	3,310	$110	$1.6M
H0004	Behavioral health counseling and therapy, per 15 minutes	3	170	8,500	$80	$1.5M
H0031	Mental health assessment, by non-physician	17	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…	578	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…	119	1,030	890	$50	$221K
A0120	Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems	1	50	1,390	$30	$183.1K
H0032	Mental health service plan development by non-physician	10	60	280	$80	$141.9K
T1017	Targeted case management, each 15 minutes	17	110	970	$20	$95.3K
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…	119	190	110	$70	$63.4K

Showing 1–10 of 17

Nearby Providers

Other providers in the same ZIP code as Tri-state Addiction Recovery Resources, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cabell Huntington Hospital Inc	WV	General Acute Care Hospital	$0	$94.1M
Autism Service Center	WV	Developmental Disabilities Clinic/Center	$0	$59M
University Physicians & Surgeons, Inc	WV	Internal Medicine Physician	$0	$58.3M
County Of Cabell	WV	Land Ambulance	$2.6M	$23.3M
Ohio Valley Physicians Inc	WV	Community/Behavioral Health Agency	$0	$22.8M
Huntington Treatment Center, LLC	WV	Methadone Clinic	$0	$21M
Valley Health Systems Inc	WV	Federally Qualified Health Center (FQHC)	$0	$13.4M
Valley Health Systems Inc	WV	Federally Qualified Health Center (FQHC)	$0	$10.2M
Valley Health Systems Inc	WV	Federally Qualified Health Center (FQHC)	$0	$10.1M
Cabell Huntington Hospital Inc	WV	General Acute Care Hospital	$0	$9.3M

Tri-state Addiction Recovery Resources — Billing Profile & Reimbursement Data

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Tri-state Addiction Recovery Resources — 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