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.

Wv Birth To Three (NPI 1871358663)

Field	Value
Entity Type	Organization
Organization	Wv Birth To Three
Address	350 Capitol St Rm 427
City	Charleston
State	WV
ZIP	25301
Taxonomy	Early Intervention Provider Agency
NPI Enumerated	February 20, 2024

Payer Source	Total Paid
Medicaid	$59.9M
Medicare	$0

Key Findings

WV BIRTH TO THREE has effectively no Medicare presence — total Medicare revenue is listed as none (no Medicare billing on file) — and is therefore operated almost entirely within the Medicaid payment stream, with lifetime Medicaid revenue of $59.9M. This makes the organization a single-payer (Medicaid-focused) billing entity in the available dataset rather than a dual-payer provider with material Medicare activity.

Revenue concentration is extremely high: the precomputed top 3 Medicaid codes by revenue account for 93.5% of this provider’s total Medicaid revenue. In particular, 97530 alone represents $44.1M in Medicaid revenue (73.6% of this provider's total Medicaid revenue), showing that the business is heavily dependent on a single therapy/service line for most of its income.

The code mix indicates an early-intervention, therapy-centric operation that pairs high-volume direct therapy with coordinated team management. 97530 (therapeutic activities; 339.1K claims, $130 avg paid/claim, $44.1M revenue) drives the bulk of direct-contact therapeutic billing, while G9007 (coordinated care fee, scheduled team conference; 56K claims, $103 avg paid/claim, $5.8M revenue) and G9002 (coordinated care fee, maintenance rate; 51.1K claims, $76 avg paid/claim, $3.9M revenue) reflect substantial billing for multidisciplinary care coordination.

The provider is a dominant in-state volume leader on its top codes. 97530 ranks #1 of 140 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code), and 96156 ranks #1 of 7 providers in-state (100th percentile; notably above typical state volume for this code), signaling market-leading scale for both direct therapy and behavioral/health behavior assessment services.

Other codes underscore a team-based care model and frequent care coordination events: 96156 (health behavior assessment; 36K claims, $171 avg paid/claim, $6.2M revenue) contributes 10.3% of the provider’s Medicaid revenue and is positioned as a top in-state reporter for that assessment activity. The combination of high-volume functional therapy (97530) and repeat behavioral assessments (96156) suggests longitudinal, multidisciplinary engagement with patients.

G9007’s metrics (56K claims, $103 avg paid/claim, $5.8M revenue) show the provider is the sole state reporter for that scheduled team conference code (ranks #1 of 1 providers in-state; 0th percentile; no state peer volume comparison available), indicating either unique billing practices for coordinated conferences or a structural role in team-based early intervention within the state. G9002 also shows high relative state volume (ranks #3 of 123 providers; 98th percentile; extreme outlier), reinforcing that coordinated-care fees are an important and unusually large component of this provider’s Medicaid business.

The provider’s NPI was enumerated on 2024-02-20 (~2 years ago), indicating a relatively recent formal registration date. Given the short reported tenure alongside very large Medicaid volumes ($59.9M lifetime and concentrated high-volume codes), the operational scale and specialization appear to have been established quickly in the Medicaid market, which may be relevant for peer benchmarking and capacity analysis.

Medicaid: Complete Services Breakdown

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

4 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	339,140	$130	$44.1M
96156	The provider assesses psychological, behavioral, emotional, cognitive, and social factors that affect a patient’s physical health, rather than assessing a specific mental health disorder. There are…	36,030	$170	$6.2M
G9007	Coordinated care fee, scheduled team conference	56,040	$100	$5.8M
G9002	Coordinated care fee, maintenance rate	51,130	$80	$3.9M

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

Wv Birth To Three — 3 of 4 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

4 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
G9007	Coordinated care fee, scheduled team conference	1	10	56,040	$100	$5.8M
G9002	Coordinated care fee, maintenance rate	3	120	2,950	$150	$901.9K
96156	The provider assesses psychological, behavioral, emotional, cognitive, and social factors that affect a patient’s physical health, rather than assessing a specific mental health disorder. There are…	1	10	60	$170	$888.7K
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.	1	140	790	$90	$469.7K

Nearby Providers

Other providers in the same ZIP code as Wv Birth To Three, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Charleston Area Medical Center Inc	WV	General Acute Care Hospital	$0	$200.1M
Charleston Area Medical Center, Inc.	WV	General Acute Care Hospital	$0	$50.9M
Children's Home Society Of West Virginia	WV	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$44.1M
Kanawha County Emergency Ambulance Authority	WV	Land Ambulance	$2.3M	$31.9M
Maxim Healthcare Services, Inc.	WV	Home Health Agency	$0	$19.9M
All-aid Services, Inc.	WV	Home Health Agency	$0	$16.3M
The Arc Of The Three Rivers, Inc.	WV	Case Management Agency	$0	$15.6M
Retina Consultants, PLLC	WV	Retina Specialist (Ophthalmology) Physician	$0	$13.6M
Dolan & Kalaskey Ltd	WV	Orthodontics and Dentofacial Orthopedics Dentistry	$0	$8.3M
Mindoula Health Inc.	WV	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$6.7M

Wv Birth To Three — Billing Profile & Reimbursement Data

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Wv Birth To Three — 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