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

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

Pathways, Inc. (NPI 1962568477)

Field	Value
Entity Type	Organization
Organization	Pathways, Inc.
Address	1212 Bath Ave
City	Ashland
State	KY
ZIP	41101
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	December 29, 2006

Payer Source	Total Paid
Medicaid	$95.4M
Medicare	$0

Key Findings

PATHWAYS, INC. is effectively a Medicaid-focused provider: there is no Medicare billing on file and the practice reports $95.4M in lifetime Medicaid revenue, indicating a single‑payer footprint centered on Medicaid rather than a mixed Medicare/Medicaid model. This concentration makes Medicaid policy and waiver rules materially important to its business performance.

Revenue is highly concentrated in a very small set of services: the top three Medicaid codes (97535, T1019, T2022) account for 87.5% of total Medicaid revenue, with 97535 alone representing $55.8M (58.5% of Medicaid revenue). That degree of concentration signals operational and reimbursement sensitivity to changes in reimbursement or utilization for those specific service lines.

The provider’s code mix indicates a business built around home- and community-based personal care, training, and case management rather than clinic-based medical procedures: 97535 (provider instruction/recovery-related services), T1019 (personal care services), and T2022 (case management monthly) together drive the bulk of revenue, with additional support from S5108 (home care training), T2040 (financial management, waiver), and T1005 (respite care). This pattern is consistent with an organization delivering large-scale waiver and personal-care programs.

PATHWAYS is a leading statewide supplier for its top therapeutic/teaching service: 97535 ranks #7 of 305 providers in-state (98th percentile; notably above typical state volume), reflecting a dominant position for that particular intervention. The provider also ranks highly for some waiver-adjacent services—T2040 ranks #4 of 43 providers (93rd percentile; notably above typical state volume) and T1005 ranks #6 of 81 providers (94th percentile; notably above typical state volume)—supporting the view that PATHWAYS is a major regional provider for select Medicaid waiver services.

For several high-revenue codes PATHWAYS shows a solid but not exceptional presence: T1019 (168.9K claims, $19.4M revenue) ranks #10 of 51 providers in-state (82th percentile; typical, unremarkable volume) and T2022 (30.6K claims, $8.2M revenue) ranks #10 of 81 providers (89th percentile; typical, unremarkable volume). These placements suggest steady, expected participation rather than outlier dominance for personal care and case management when compared to peers.

Operational scale is substantial based on claim volumes: PATHWAYS submitted 453.7K claims for 97535 and 168.9K claims for T1019, implying a high-throughput model with sizable administrative and care-delivery capacity to manage frequent, time-based services. Such volumes are consistent with home- and community-based program delivery at scale.

Although the top three codes dominate revenue, PATHWAYS also bills a range of complementary waiver and home-care supports (S5108, T2040, T1005, T2021). Some of those—T2040 and T1005—are listed as notably above typical state volume, indicating pockets of comparative strength beyond the single largest code, while others (S5108, T2021) show typical, unremarkable volume; this mix implies some diversification within the broader waiver/personal-care service set even as overall revenue concentration remains high.

PATHWAYS has a long-tenured presence in the Medicare/Medicaid NPI registry, enumerated on 2006-12-29 (~20 years ago), which supports that its Medicaid-focused service model and high-volume operational processes are established rather than newly developed. Longevity combined with the current Medicaid concentration suggests institutional experience in administering waiver and personal-care programs in Kentucky.

Medicaid: Complete Services Breakdown

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

7 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	453,690	$120	$55.8M
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	168,880	$120	$19.4M
T2022	Case management, per month	30,620	$270	$8.2M
S5108	Home care training to home care client, per 15 minutes	57,600	$100	$5.5M
T2040	Financial management, self-directed, waiver; per 15 minutes	60,480	$50	$3.1M
T1005	Respite care services, up to 15 minutes	47,210	$60	$2.7M
T2021	Day habilitation, waiver; per 15 minutes	10,510	$60	$599.1K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Pathways, Inc. — 1 of 7 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

7 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5108	Home care training to home care client, per 15 minutes	44	100	43,820	$140	$16.6M
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	10	50	13,600	$140	$11.1M
T2022	Case management, per month	10	80	7,120	$290	$4.1M
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	7	310	830	$120	$3.7M
T2040	Financial management, self-directed, waiver; per 15 minutes	4	40	14,910	$160	$3.5M
T2021	Day habilitation, waiver; per 15 minutes	95	150	16,130	$70	$1.7M
T1005	Respite care services, up to 15 minutes	6	80	2,880	$70	$799.2K

Related Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pathways Inc	KY	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$82.2M
Aaron Smith	KY	Clinical Psychologist	$69.4K	$0
Margaret Taylor	KY	Clinical Social Worker	$58.6K	$0
Patricia Rudd	KY	Clinical Social Worker	$37.6K	$0
Mark Mcdaniel	WV	Family Medicine Physician	$22.9K	$0

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ashland Hospital Corporation	KY	General Acute Care Hospital	$0	$222.9M
A Brighter Future	KY	Community/Behavioral Health Agency	$0	$39.8M
A Center 4 Change	KY	Counseling Psychologist	$0	$22M
Fivco Add Cdo As Fiscal Agent	KY	Supports Brokerage Agency	$0	$21M
Our Lady Of Bellefonte Hospital Inc	KY	General Acute Care Hospital	$0	$12.1M
Advocate Medical Services, LLC	KY	Durable Medical Equipment & Medical Supplies	$0	$10.6M
Ultimate Care Behavioral Health Services	KY	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$10.6M
Wecare Medical, LLC	KY	Oxygen Equipment & Supplies (DME)	$0	$9.9M
Nancy Mussetter	KY	Dentist	$0	$8M
West Fairview Emergency Physicians LLC	KY	Emergency Medicine Physician	$0	$7.2M

Pathways, Inc. — Billing Profile & Reimbursement Data

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Pathways, 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

Related Providers

Nearby Providers

Frequently Asked Questions

References