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

Why is the Medicaid comparison limited to 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. 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.

Horizon Behavioral Health (NPI 1871542340)

Field	Value
Entity Type	Organization
Organization	Horizon Behavioral Health
Address	2215 Langhorne Rd
City	Lynchburg
State	VA
ZIP	24501
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	May 10, 2006

Payer Source	Total Paid
Medicaid	$138.1M
Medicare	$0

Key Findings

This provider is effectively a Medicaid-centered organization with no Medicare billing on file and lifetime Medicaid revenue of $138.1M; its NPI was enumerated on 2006-05-10 (~20 years ago), indicating long-tenured participation in the state Medicaid program. The absence of Medicare activity makes Medicaid the sole observable public-payer revenue stream for analysis.

Revenue is highly concentrated: the top three Medicaid codes (H0023, T1017, 90837) account for 68.3% of the provider's total Medicaid revenue, with H0023 alone representing $63.7M (46.3% of Medicaid revenue). That single-code concentration signals that a large share of dollars flows through outreach services rather than a more diversified outpatient mix.

The service mix implied by leading codes points to a community behavioral health operating model focused on outreach, case management, and intensive psychotherapy: H0023 (behavioral health outreach), T1017 (targeted case management), and 90837 (long psychotherapy sessions) together drive most revenue. High volumes in H0035 (partial hospitalization) and H0040 (assertive community treatment per diem) further indicate the organization runs both structured day-programs and community-based treatment teams.

Competitive standing within Virginia is strong and in some areas dominant: the provider ranks #1 of 1337 for 90837 (100th percentile) and is described as an extreme outlier, showing far higher statewide volume for long psychotherapy than typical peers. It also ranks #2 of 50 for H0023 (98th percentile), which positions the provider as one of the state’s leading behavioral health outreach organizations.

Several other codes show outsized statewide presence beyond the top three: H0036 (community psychiatric supportive treatment) ranks #1 of 54 (100th percentile) and 90791 (psychiatric evaluation) ranks #2 of 612 (100th percentile), indicating the provider is a top deliverer of both initial psychiatric evaluations and community face-to-face supportive services. These high ranks across diagnostic and supportive codes suggest broad clinical capacity, not just a single narrow program.

Claim volumes demonstrate substantial ambulatory throughput: H0023 has 190.8K claims and 90837 has 114.1K claims, with H0035 at 84.8K claims and 99214 at 51.7K claims. The combination of high claim counts and the presence of time-based per-15-minute codes implies heavy utilization of frequent, longitudinal services rather than predominantly one-off encounters.

The payor- and code-level concentration creates exposure to policy or payment changes for a few high-impact codes—because the top three codes already account for 68.3% of Medicaid revenue, any rate adjustments or eligibility shifts for H0023, T1017, or 90837 would materially affect overall revenue. Analysts should monitor state reimbursement policy and utilization trends for outreach, targeted case management, and long psychotherapy services when assessing financial risk.

Intensity and program structure are evident from elevated average paid/claim values on time-based and crisis codes (for example, H2011 shows $664 avg paid/claim and ranks #5 of 228 as an extreme outlier, and H2019 shows $327 avg paid/claim at the 96th percentile). This combination of high per-claim payments on crisis and intensive therapeutic codes, plus large volumes of outreach and psychotherapy, signals an operational model built around resource-intensive community and crisis services rather than only low-intensity office visits.

Medicaid: Complete Services Breakdown

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

44 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0023	Alcohol and/or drug outreach	190,790	$330	$63.7M
T1017	Targeted case management, each 15 minutes	53,230	$340	$17.9M
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…	114,140	$110	$12.4M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	84,790	$100	$8.3M
H2019	Therapeutic behavioral services, per 15 minutes	13,420	$330	$4.4M
H0040	Assertive community treatment program, per diem	18,830	$210	$3.9M
H0015	Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including…	14,490	$240	$3.4M
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…	51,660	$70	$3.4M
H2011	Crisis intervention service, per 15 minutes	5,040	$660	$3.3M
H0039	Assertive community treatment, face-to-face, per 15 minutes	6,500	$390	$2.5M

Showing 1–10 of 44

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Virginia Distribution

Horizon Behavioral Health — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

44 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0023	Alcohol and/or drug outreach	2	50	33,630	$320	$15M
T1017	Targeted case management, each 15 minutes	7	50	23,860	$330	$9.4M
H2033	Multisystemic therapy for juveniles, per 15 minutes	49	80	5,390	$210	$3.8M
H0046	Mental health services, not otherwise specified	398	510	6,100	$190	$2.8M
H0040	Assertive community treatment program, per diem	9	40	10,830	$200	$2.7M
H2034	Alcohol and/or drug abuse halfway house services, per diem	22	20	8,970	$160	$2.6M
H0039	Assertive community treatment, face-to-face, per 15 minutes	7	30	2,740	$530	$2M
H0035	Mental health partial hospitalization, treatment, less than 24 hours	9	150	5,420	$110	$1.9M
H2017	Psychosocial rehabilitation services, per 15 minutes	38	100	15,920	$60	$1.9M
S9482	Family stabilization services, per 15 minutes	121	180	650	$1,070	$1.7M

Showing 1–10 of 44

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Shameca Hudson	MS	Psychiatric/Mental Health Nurse Practitioner	$2.5K	$0

Nearby Providers

Other providers in the same ZIP code as Horizon Behavioral Health, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lutheran Family Services Of Virginia, Inc.	VA	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$194.3M
Brightview LLC	VA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$32M
Centra Health Inc	VA	General Acute Care Hospital	$0	$18.5M
Virginia Treatment Center, LLC	VA	Methadone Clinic	$116.5K	$15.9M
Robert Brennan	VA	Infectious Disease Physician	$15.9M	$0
Cabaniss Consultants LLC	VA	Developmentally Disabled Services Day Training Agency	$0	$10.9M
Sense Of Security Care, Inc.	VA	Home Health Aide	$0	$9.2M
Surgery Center Of Lynchburg LLC	VA	Ambulatory Surgical Clinic/Center	$4M	$799.8K
Landon Colling	VA	Ophthalmology Physician	$2.8M	$190
Jong An	VA	Hematology & Oncology Physician	$2.4M	$0

Horizon Behavioral Health — Billing Profile & Reimbursement Data

Sign up for Horizon Behavioral Health — Billing Profile & Reimbursement Data policy alerts

Horizon Behavioral Health — Billing Profile & Reimbursement Data

Sign up for Horizon Behavioral Health — Billing Profile & Reimbursement Data policy alerts

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