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.

3 Rivers Mental Health Solutions LLC (NPI 1861729535)

Field	Value
Entity Type	Organization
Organization	3 Rivers Mental Health Solutions LLC
Address	1620 Regent St Ste A
City	Missoula
State	MT
ZIP	59801
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	November 17, 2009

Payer Source	Total Paid
Medicaid	$16.7M
Medicare	$0

Key Findings

3 RIVERS MENTAL HEALTH SOLUTIONS LLC is effectively a Medicaid-focused provider: there is no Medicare billing on file and lifetime Medicaid revenue is $16.7M, so the practice operates as a single-payer (Medicaid) revenue model rather than a mixed Medicare/Medicaid practice. This concentration on Medicaid should be a primary lens for any payer or competitive analysis.

Revenue is highly concentrated in a small set of services: the precomputed top three Medicaid codes (S5102, T1016, 99214) account for 89.8% of the provider's Medicaid revenue. Those three codes individually contribute $6.1M (36.8%), $5.2M (31.0%), and $3.7M (22.0%) respectively, indicating a narrow set of revenue drivers.

The code mix suggests a blended operational model combining adult day programming, intensive case management, and high-volume office-based evaluation and management. Specifically, S5102 (day care services, adult; per diem) shows 39.6K claims and $6.1M revenue, T1016 (case management, each 15 minutes) shows 97.7K claims and $5.2M revenue, and 99214 (established outpatient E/M) shows 33.8K claims and $3.7M revenue — together these imply concurrent day-program capacity plus substantial outpatient visit throughput.

99214 is a notable statistical outlier in the state: it ranks #9 of 532 providers (98th percentile; extreme outlier, far above typical state volume) with 33.8K claims and $3.7M revenue, signaling that this provider delivers E/M services at a scale well above most in-state peers. Psychotherapy code 90837 also stands out with 12.2K claims, $657.2K revenue and a 99th percentile rank (notably above typical state volume), which together indicate unusually high volume of face-to-face clinical services in addition to day programs.

By contrast, S5102 and T1016 show strong but not dominant statewide positions: S5102 ranks #2 of 8 (86th percentile; typical, unremarkable volume) and T1016 ranks #4 of 53 (94th percentile; typical, unremarkable volume). These placements mean the provider is a major local participant in adult day care and case management without being the statewide dominant provider for those services.

Operational and payer-risk implications flow from the concentration: relying on S5102, T1016, and 99214 for 89.8% of Medicaid revenue exposes the organization to reimbursement or policy changes affecting adult day per diems, time-based case management, or outpatient E/M. The very high claim counts for T1016 (97.7K claims) and S5102 (39.6K claims) also indicate an operational model built around time- and per-diem billing, which could amplify revenue volatility if utilization patterns shift.

The provider offers a broader set of behavioral services beyond the top three codes but these represent smaller shares of revenue. Examples include H2019 (therapeutic behavioral services) at 23.1K claims and $601.6K revenue, H2012 (behavioral health day treatment) at 3.7K claims and $125.5K revenue, and 90791 (psychiatric evaluation) at 1.3K claims and $88.2K revenue; these lines show breadth of clinical offerings but are secondary to the day-care/case-management/E/M triad.

The organization has an established presence in the market, with NPI enumerated on 2009-11-17 (~17 years ago), suggesting sustained operations and an entrenched Medicaid orientation. Combined with the unusually high state-level volumes on key outpatient and psychotherapy codes, the tenure supports a profile of a mature, Medicaid-focused behavioral health provider with concentrated revenue streams that warrant monitoring for policy or utilization shifts.

Medicaid: Complete Services Breakdown

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S5102	Day care services, adult; per diem	39,630	$160	$6.1M
T1016	Case management, each 15 minutes	97,740	$50	$5.2M
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…	33,760	$110	$3.7M
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…	12,170	$50	$657.2K
H2019	Therapeutic behavioral services, per 15 minutes	23,140	$30	$601.6K
90833	In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the…	2,290	$60	$137.6K
H2012	Behavioral health day treatment, per hour	3,690	$30	$125.5K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	1,340	$70	$88.2K
99205	The provider sees a new 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 provider…	340	$160	$53.6K
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…	2,180	$10	$19.6K

Showing 1–10 of 13

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

3 Rivers Mental Health Solutions LLC — 2 of 13 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

13 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5102	Day care services, adult; per diem	2	10	16,590	$280	$7.2M
H2012	Behavioral health day treatment, per hour	11	20	27,640	$60	$2M
T1016	Case management, each 15 minutes	4	50	2,720	$50	$1.4M
H2019	Therapeutic behavioral services, per 15 minutes	8	40	3,280	$50	$759.9K
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…	9	530	580	$70	$224.6K
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…	18	1,200	750	$80	$143.2K
90833	In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the…	9	60	380	$70	$91.2K
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…	26	50	50	$140	$61K
96103	N/A	2	10	2,000	$20	$43K
99205	The provider sees a new 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 provider…	13	70	70	$180	$40.4K

Showing 1–10 of 13

Related Providers

Other providers that share a Tax Identification Number (TIN) with 3 Rivers Mental Health Solutions LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Michael Thein	MT	Psychiatry Physician	$64.1K	$0
Jeffrey Doyle	MT	Clinical Social Worker	$21.7K	$0

Nearby Providers

Other providers in the same ZIP code as 3 Rivers Mental Health Solutions LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Western Montana Mental Health Center	MT	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$87.8M
Opportunity Resources Inc	MT	Developmentally Disabled Services Day Training Agency	$0	$48.5M
Missoula Developmental Service Corp	MT	Non-emergency Medical Transport (VAN)	$0	$33.6M
Express Personnel Services	MT	Nursing Care Agency	$0	$20.4M
Missoula County Public Schools	MT	Local Education Agency (LEA)	$0	$16.3M
Meadowlark Home Care LLC	MT	Home Health Agency	$0	$12.9M
Client Dedicated Services, Inc	MT	Home Health Agency	$0	$10.6M
Children's Dentistry Of The Rockies	MT	Pediatric Dentistry	$0	$10.1M
Missoula Pediatric Dentistry PC	MT	Pediatric Dentistry	$0	$9.3M
Missoula Oral Surgery	MT	Oral and Maxillofacial Surgery Clinic/Center	$0	$8M

3 Rivers Mental Health Solutions LLC — Billing Profile & Reimbursement Data

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3 Rivers Mental Health Solutions LLC — 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