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

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

Recovery House, Inc. (NPI 1922051242)

Field	Value
Entity Type	Organization
Organization	Recovery House, Inc.
Address	98 Church St
City	Wallingford
State	VT
ZIP	05773
Taxonomy	Addiction Medicine (Psychiatry & Neurology) Physician
NPI Enumerated	May 18, 2006

Payer Source	Total Paid
Medicaid	$10.2M
Medicare	$0

Key Findings

RECOVERY HOUSE, INC. reports no Medicare billing on file and $10.2M in lifetime Medicaid revenue, making Medicaid the effective sole public payer in this profile. The absence of Medicare activity indicates the organization operates almost entirely within the Medicaid-funded behavioral health market rather than the Medicare population.

Revenue is highly concentrated: the precomputed top 3 Medicaid codes by revenue account for 100.0% of this provider's total Medicaid revenue, with a single code dominating the mix. H0018 alone represents $10M (97.8% of total Medicaid revenue) and should be treated as the provider's primary revenue driver.

The code mix points to a residential addiction-treatment business model: H0018 (short-term residential, per diem) accounts for the vast majority of revenue and reflects operation of a non-hospital residential treatment program. H0011 (acute detoxification inpatient) and 90853 (group psychotherapy) are present but together represent only a small fraction of revenue, indicating outpatient group therapy is a minor component of billed services.

Utilization patterns support the residential focus: H0018 shows 3.3K claims with an average paid/claim of $3007, H0011 shows 244 claims at $888 avg paid/claim, and 90853 shows 677 claims at $15 avg paid/claim. These claim counts and payment differentials underscore that bed-day/per-diem billing is the primary operational and financial activity.

Competitive standing within Vermont is modest and non-dominant for the provider's top codes. H0018 ranks #2 of 3 providers in-state (50th percentile; typical, unremarkable volume for this code), H0011 ranks #2 of 2 providers (0th percentile; typical, unremarkable volume for this code), and 90853 ranks #14 of 36 providers in-state (63th percentile; typical, unremarkable volume).

The concentration in H0018 creates both operational leverage and financial vulnerability: any policy, rate, or utilization changes affecting short-term residential per-diem payments could materially impact the provider’s Medicaid revenue given that H0018 is $10M (97.8% of Medicaid revenue). Conversely, the provider may have opportunity to diversify revenue by expanding services that currently contribute minimal revenue, such as group psychotherapy (90853).

Service-level interpretation of payments highlights different revenue intensities: the average paid/claim for H0018 is $3007 versus $888 for H0011 and only $15 for 90853, indicating that residential bed-days drive revenue while psychotherapy encounters are low-revenue volume. This gap suggests operations are capital- and bed-focused rather than outpatient therapy–driven.

The provider’s NPI tenure is long-established, enumerated 2006-05-18 (~20 years ago), which supports an interpretation of sustained operation in the state Medicaid market rather than a recent entrant. That tenure, combined with the concentrated service mix, suggests an entrenched residential treatment offering within Vermont’s behavioral health ecosystem.

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	3,330	$3,010	$10M
H0011	Alcohol and/or drug services; acute detoxification (hospital inpatient) per diem	240	$890	$216.7K
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	680	$20	$10.2K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Vermont Distribution

Recovery House, Inc. — 0 of 3 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. Vermont median

3 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	2	10	3,330	$2,480	$11.2M
H0011	Alcohol and/or drug services; acute detoxification (hospital inpatient) per diem	2	10	1,490	$2,490	$3.7M
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	14	40	380	$10	$13.8K

Nearby Providers

Other providers in the same ZIP code as Recovery House, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Maple Leaf Clinic PC	VT	Clinical Psychologist	$0	$1.6M
Thrive Center Of The Green Mountains Inc	VT	Chiropractor	$0	$104.4K
David Baasch	VT	General Practice Dentistry	$0	$69.4K
Brian Finch	VT	Physical Therapist	$52.4K	$0
Dean Mooney	VT	Clinical Psychologist	$42.8K	$8.8K
Wallingford Rescue, Inc.	VT	Ambulance	$40.1K	$0

Recovery House, Inc. — Billing Profile & Reimbursement Data

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Recovery House, Inc. — 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