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

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

Pyramid Healthcare (NPI 1811018898)

Field	Value
Entity Type	Organization
Organization	Pyramid Healthcare
Address	3893 West Main Street
City	Belleville
State	PA
ZIP	17004
Taxonomy	Substance Abuse Rehabilitation Facility
NPI Enumerated	April 3, 2007

Payer Source	Total Paid
Medicaid	$87.4M
Medicare	$0

Key Findings

PYRAMID HEALTHCARE reports $87.4M in lifetime Medicaid revenue and has no Medicare billing on file, making Medicaid the effectively exclusive public payer in the claims record. This concentration means payer-mix analysis and revenue forecasting should be driven almost entirely by Medicaid policy and rate behavior in Pennsylvania.

The provider’s billing mix is concentrated on residential behavioral health per-diem services, with the top codes reflecting short-term and long-term non-hospital residential treatment: H0018 (Behavioral health; short-term residential, without room and board, per diem), H2036 (Alcohol and/or other drug treatment program, per diem), and T2048 (Behavioral health; long-term care residential with room and board, per diem). This code mix indicates PYRAMID operates high-volume residential substance use disorder treatment capacity across both short- and long-stay modalities.

Revenue concentration is extreme: the top three Medicaid codes account for 100.0% of this provider’s Medicaid revenue, with H0018 representing 51.0%, H2036 representing 34.0%, and T2048 representing 15.0% of the $87.4M total. Such concentration on three per-diem residential codes implies material revenue exposure to reimbursement or utilization changes for those specific service lines.

Volume and payment detail reinforce the residential operating model: H0018 had 171.3K claims at $260 avg paid/claim yielding $44.5M revenue; H2036 had 99.3K claims at $299 avg paid/claim yielding $29.7M revenue; and T2048 had 51.1K claims at $257 avg paid/claim yielding $13.1M revenue. These high claim counts with per-diem average paid amounts are consistent with continuous residential occupancy rather than episodic outpatient encounters.

PYRAMID is a dominant in-state provider for two of its top codes and a high-volume participant on the third: H0018 ranks #1 of 95 providers in-state (100th percentile; extreme outlier, far above typical state volume) and T2048 ranks #1 of 58 providers in-state (100th percentile; extreme outlier, far above typical state volume), while H2036 ranks #6 of 117 providers in-state (96th percentile; notably above typical state volume). These rankings indicate the provider is a market leader for short-term and long-term residential billing in Pennsylvania and a major player for alcohol/drug per-diem services.

Operational and financial risk considerations stem from the single-payer profile and narrow service mix: with no Medicare billing on file and 100.0% of Medicaid revenue tied to three per-diem residential codes, changes in Medicaid policy, per-diem rates, or utilization patterns for residential substance-use treatment could materially affect revenue. Analysts should prioritize monitoring state Medicaid rate adjustments, authorization policies, and utilization management for these specific codes.

PYRAMID’s NPI was enumerated on 2007-04-03 (~19 years ago), indicating an established provider history in the market. Coupled with the scale and percentile rankings on residential behavioral health codes, the tenure supports characterization as a longstanding, high-capacity specialty residential substance abuse treatment operator in Pennsylvania.

Medicaid: Complete Services Breakdown

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

3 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	171,330	$260	$44.5M
H2036	Alcohol and/or other drug treatment program, per diem	99,350	$300	$29.7M
T2048	Behavioral health; long-term care residential (non-acute care in a residential treatment program where stay is typically longer than 30 days), with room and board, per diem	51,120	$260	$13.1M

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Pyramid Healthcare — 3 of 3 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

3 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2036	Alcohol and/or other drug treatment program, per diem	6	120	7,190	$420	$8.7M
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	1	100	5,130	$370	$4.5M
T2048	Behavioral health; long-term care residential (non-acute care in a residential treatment program where stay is typically longer than 30 days), with room and board, per diem	1	60	1,280	$360	$1.8M

Related Providers

Other providers that share a Tax Identification Number (TIN) with Pyramid Healthcare, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pyramid Health Care Inc.	PA	Substance Abuse Rehabilitation Facility	$0	$128.8M
Pyramid Healthcare, Inc.	VA	Community/Behavioral Health Agency	$0	$40.6M
Pyramid Health Care Inc.	PA	Substance Abuse Rehabilitation Facility	$0	$23.9M
Pyramid Healthcare Inc.	PA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$14.3M
Pyramid Healthcare Inc.	PA	Methadone Clinic	$125.2K	$13.3M
Pyramid Healthcare Inc.	PA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$11M
Pyramid Healthcare Inc.	PA	Substance Abuse Rehabilitation Facility	$0	$10.4M
Pyramid Healthcare Inc.	PA	Substance Abuse Rehabilitation Facility	$0	$8.6M
Pyrmaid Healthcare Inc.	PA	Methadone Clinic	$96.6K	$8.1M
Pyramid Healthcare Inc	PA	Children's Substance Abuse Rehabilitation Facility	$0	$8.2M

Pyramid Healthcare — 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

Frequently Asked Questions

References