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

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

Montana Children's Home & Hospital (NPI 1811056898)

Field	Value
Entity Type	Organization
Organization	Montana Children's Home & Hospital
Address	2755 Colonial Dr
City	Helena
State	MT
ZIP	59601
Taxonomy	General Acute Care Hospital
NPI Enumerated	December 6, 2006

Payer Source	Total Paid
Medicaid	$8.7M
Medicare	$0

Key Findings

MONTANA CHILDREN'S HOME & HOSPITAL is effectively a single-payer Medicaid provider: there is no Medicare billing on file while total Medicaid revenue is $8.7M, indicating its operations are focused on Medicaid-covered services rather than Medicare beneficiaries. The absence of Medicare activity suggests the facility primarily serves pediatric or child-focused populations consistent with its name and Medicaid-funded programs.

Revenue concentration is high among a few services: the precomputed top three Medicaid codes account for 43.2% of the provider's total Medicaid revenue. This concentration indicates that a limited set of care lines — particularly inpatient subsequent care (99232, 99233) and a foster care per diem (S5145) — drive nearly half of the facility's Medicaid income, exposing the provider to utilization shifts in those services.

Clinical/service-line mix points to inpatient follow-up and behavioral/child welfare services as core operations. High volumes and revenue for 99232 and 99233 (each contributing roughly $1.3M and $1.2M respectively) indicate substantial subsequent inpatient/observation care activity, while S5145 (foster care, therapeutic, child; per diem) at $1.2M reflects institutional foster care or therapeutic residential services rather than only outpatient clinic work.

The provider shows a strong behavioral health and case management footprint in addition to inpatient care. Codes such as H2012 (behavioral health day treatment, $715.3K), T1016 (case management, $820K), and multiple psychotherapy codes (90837, 90834) together represent a significant portion of Medicaid revenue and suggest integrated behavioral health programming and care coordination are important service lines.

State competitive standing is mixed: for key inpatient subsequent visit codes the provider ranks highly in Montana. 99233 ranks #2 of 26 providers in-state and is described as notably above typical state volume, and 99231 ranks #1 of 15 providers (100th percentile) which together indicate the hospital is a major state provider for higher-acuity subsequent inpatient evaluation and management. Other high-revenue codes such as S5145 and H2012 rank in mid-to-lower percentiles (43rd and 36th), showing it is less dominant in foster-care per diem and day-treatment compared with some peers.

Several codes are statistical outliers in the state context, highlighting particular strengths: 99231 is a 100th-percentile volume for Montana (notably above typical state volume) and 99417 also ranks #1 of 11 providers (100th percentile), indicating unusually high use of extended outpatient E/M time. Conversely, many behavioral health and psychotherapy codes have high percentiles (e.g., 90837 at the 92nd percentile, 90834 at 93rd) but are characterized as typical volumes for those statewide peer groups, signaling broad but not exceptional behavioral service activity.

The provider has long tenure in NPI registration, enumerated since 2006-12-06 (~20 years ago), which supports interpretation of sustained service patterns and revenue mix rather than a short-term or new entrant effect. This longevity aligns with established inpatient and behavioral health program offerings implied by the billing profile.

Operational risk and planning considerations follow from the concentrated payer and code mix: because Medicaid accounts for all reported federal payer revenue ($8.7M) and 43.2% of that revenue is tied to the top three codes, shifts in Medicaid policy, reimbursement, or utilization for inpatient subsequent care or foster-care per diems could materially affect overall revenue. Analysts should monitor state Medicaid policy and utilization trends for 99232/99233 and S5145 when evaluating financial resilience and negotiating contracts.

Medicaid: Complete Services Breakdown

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

35 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	15,080	$80	$1.3M
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	10,410	$120	$1.2M
S5145	Foster care, therapeutic, child; per diem	7,540	$170	$1.2M
T1016	Case management, each 15 minutes	15,470	$50	$820K
H2012	Behavioral health day treatment, per hour	11,920	$60	$715.3K
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…	5,210	$140	$708.2K
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…	2,590	$200	$526.6K
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…	4,830	$90	$439.1K
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…	4,590	$60	$275.6K
99231	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a straightforward or low level of medical…	5,560	$50	$250.2K

Showing 1–10 of 35

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

Montana Children's Home & Hospital — 4 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

35 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5145	Foster care, therapeutic, child; per diem	5	10	10,460	$230	$12.3M
H2012	Behavioral health day treatment, per hour	10	20	27,640	$60	$2M
T1016	Case management, each 15 minutes	14	50	2,720	$50	$1.4M
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…	4	30	770	$60	$233.3K
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…	71	530	580	$70	$224.6K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	79	150	2,760	$40	$224.3K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	45	200	1,110	$60	$207.2K
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…	298	520	730	$40	$196.4K
99233	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a high level of medical decision making or the…	2	30	640	$90	$188.1K
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…	101	1,200	750	$80	$143.2K

Showing 1–10 of 35

Related Providers

Other providers that share a Tax Identification Number (TIN) with Montana Children's Home & Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Montana Children's Home & Hospital	MT	Adolescent and Children Mental Health Clinic/Center	$0	$1.1M
Cindie Woods	MT	Clinical Social Worker	$0	$213.6K

Nearby Providers

Other providers in the same ZIP code as Montana Children's Home & Hospital, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
West Mont	MT	Adult Care Home Facility	$0	$34.7M
Intermountain Deaconess Home	MT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$11.9M
County Of Lewis & Clark Lewis & Clark County School District #1	MT	Local Education Agency (LEA)	$0	$10.8M
Pediatric Dentistry PC	MT	Pediatric Dentistry	$0	$9.9M
Region Iv Family Outreach, Inc	MT	Case Manager/Care Coordinator	$0	$7.3M
Lewis And Clark Emergency Physicians P C	MT	Emergency Medicine Physician	$0	$6.6M
Montana Independent Living Project	MT	In Home Supportive Care Agency	$0	$6M
St. Peter's Health	MT	Family Medicine Physician	$0	$5.2M
Edgewood Helena Senior Living LLC	MT	Assisted Living Facility	$0	$4.7M
Montana Surgery Center	MT	Ambulatory Surgical Clinic/Center	$0	$4.6M

Montana Children's Home & Hospital — Billing Profile & Reimbursement Data

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Montana Children's Home & Hospital — 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