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

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

Plains Area Mental Health, Inc. (NPI 1801867734)

Field	Value
Entity Type	Organization
Organization	Plains Area Mental Health, Inc.
Address	180 10th St Se
City	Le Mars
State	IA
ZIP	51031
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	January 30, 2006

Payer Source	Total Paid
Medicaid	$34.1M
Medicare	$0

Key Findings

This provider is effectively single-payer in scope: there is no Medicare billing on file while total Medicaid revenue is $34.1M, indicating PLAINS AREA MENTAL HEALTH, INC. operates almost entirely within the Medicaid program rather than Medicare. Analysts should treat Medicaid as the material payer when evaluating financial exposure and service delivery for this entity.

Revenue is highly concentrated in a very small set of codes: the precomputed top three Medicaid codes account for 81.6% of the provider’s Medicaid revenue, driven by 99490 ($19.2M, 56.4%), 90834 ($6.4M, 18.9%), and H0037 ($2.2M, 6.4%). This concentration means changes to payment policy or utilization for any of these three codes would materially affect the provider’s top-line Medicaid revenue.

Operationally, the code mix points to a large outpatient behavioral health and care-management operation: heavy volumes of psychotherapy codes (90834: 70.8K claims; 90832: 17.2K claims; 90837: 7K claims) together with psychiatric evaluation (90791: 10.8K claims) and per-diem community psychiatric supportive treatment (H0037: 13.2K claims) indicate regular, ongoing therapy and supportive services for a substantial caseload. The dominant presence of 99490 (130.9K claims) further suggests the provider runs extensive provider-directed clinical staff chronic care management programs.

State-level competitive standing is strong and, for several codes, extreme relative to peers: 99490 ranks #2 of 57 providers in-state (98th percentile; extreme outlier), 90834 ranks #6 of 675 (99th percentile; extreme outlier), and 90791 ranks #3 of 401 (100th percentile; extreme outlier). These percentile and rank positions characterize PLAINS AREA MENTAL HEALTH, INC. as a dominant statewide provider for chronic care management and psychotherapy services.

The provider also demonstrates a substantial telehealth and administrative coordination footprint: Q3014 (telehealth originating site) shows 20.2K claims and $344.1K revenue, ranking #2 of 75 providers in-state (99th percentile; extreme outlier). At the same time, several care-coordination and chronic care planning codes report very high claim counts with $0 avg paid/claim (for example, G9008 73.9K claims, G0506 54.7K claims, and 99439 17.1K claims), indicating a large volume of reported coordination activity that contributes to the operational profile even where recorded payment in this dataset is zero.

The pattern of heavy usage of chronic care management and coordinated-care codes (99490 and related codes such as 99439 and G0506) alongside high psychotherapy volumes suggests a population with ongoing, complex behavioral health needs. This mix implies sustained longitudinal engagement with patients rather than episodic, one-off contacts, aligning with the role of a community mental health clinic or center.

The provider has institutional tenure in the dataset, with its NPI enumerated on 2006-01-30 (~20 years ago), and the absolute claim volumes (e.g., 130.9K claims for 99490 and 70.8K claims for 90834) reflect a long-established, high-throughput outpatient behavioral health operation. For analysts modeling capacity, patient panels, or workforce needs, these claim volumes signal sizeable ongoing service delivery rather than a small or new entrant.

Reliance on a narrow set of high-volume codes creates revenue concentration risk: because 99490, 90834, and H0037 together represent 81.6% of Medicaid revenue, policy or utilization shifts affecting chronic care management, psychotherapy reimbursement, or per-diem supportive treatment could disproportionately impact the provider’s fiscal stability. Monitoring state-level policy changes and utilization trends for these specific codes should be a priority for payer/provider analysts.

Medicaid: Complete Services Breakdown

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

28 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99490	The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the…	130,880	$150	$19.2M
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…	70,810	$90	$6.4M
H0037	Community psychiatric supportive treatment program, per diem	13,180	$170	$2.2M
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…	25,560	$60	$1.6M
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	10,780	$130	$1.4M
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…	17,250	$50	$793.4K
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…	7,030	$100	$667.9K
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…	11,280	$50	$507.8K
Q3014	Telehealth originating site facility fee	20,240	$20	$344.1K
T2021	Day habilitation, waiver; per 15 minutes	8,270	$30	$281.2K

Showing 1–10 of 28

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Iowa Distribution

Plains Area Mental Health, Inc. — 6 of 19 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Iowa

Full comparison — all codes billed, vs. Iowa median

28 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99490	The clinical staff provides services directed by the provider to support and coordinate a patient’s care across multiple disciplines. The patient has two or more chronic conditions that place the…	2	60	16,120	$150	$3.8M
H0037	Community psychiatric supportive treatment program, per diem	3	30	1,050	$210	$800.8K
T2021	Day habilitation, waiver; per 15 minutes	25	100	2,780	$60	$386.9K
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	680	670	$70	$343.5K
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…	43	120	980	$50	$230.3K
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…	28	1,060	480	$40	$154.5K
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…	147	1,310	760	$20	$153.1K
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…	40	610	550	$70	$145.9K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	3	400	110	$100	$101.1K
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…	3	280	530	$40	$80.1K

Showing 1–10 of 28

Related Providers

Other providers that share a Tax Identification Number (TIN) with Plains Area Mental Health, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Laurie Warren	IA	Physician Assistant	$39.4K	$0
Kaye Cleveland	IA	Psychiatric/Mental Health Nurse Practitioner	$16.2K	$0
Sarah Berte-greinert	IA	Clinical Social Worker	$5.8K	$0
Anthony Larson	IA	Psychologist	$3.2K	$0

Nearby Providers

Other providers in the same ZIP code as Plains Area Mental Health, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Plymouth Life, Inc.	IA	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$47M
Life Skills Training Center, Inc.	IA	Developmentally Disabled Services Day Training Agency	$0	$3.9M
Floyd Valley Healthcare	IA	Critical Access Hospital	$0	$1.6M
Floyd Valley Healthcare	IA	Family Medicine Physician	$0	$1.3M
City Of Lemars	IA	Land Ambulance	$136.2K	$146.5K
Gary Tillman	IA	Certified Registered Nurse Anesthetist	$27.3K	$0
Elizabeth Groetken	IA	Optometrist	$25.5K	$0

Plains Area Mental Health, Inc. — Billing Profile & Reimbursement Data

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Plains Area Mental Health, Inc. — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References