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 1982615043)

Field	Value
Entity Type	Organization
Organization	Pathways Inc
Address	1212 Bath Ave Fl 8
City	Ashland
State	KY
ZIP	41101
Taxonomy	Mental Health Clinic/Center (Including Community Mental Health Center)
NPI Enumerated	August 11, 2006

Payer Source	Total Paid
Medicaid	$82.2M
Medicare	$0

Key Findings

PATHWAYS INC is effectively a Medicaid-focused behavioral health provider with no Medicare billing on file and $82.2M in lifetime Medicaid revenue, indicating the organization operates almost entirely within the state Medicaid market rather than serving Medicare populations. The absence of Medicare revenue makes this entity functionally single-payer (Medicaid) for the claims data available, so analyses of scale and competitive standing should be framed against in-state Medicaid peers.

Revenue concentration is high among a few services: the top three Medicaid codes by revenue account for 40.5% of total Medicaid revenue, and three individual codes each contribute double-digit shares (90837 at $14.3M or 18.0%, T2023 at $11.7M or 14.7%, and H2019 at $6.3M or 7.9%). This concentration implies PATHWAYS’ financial performance is materially tied to high-volume psychotherapy, monthly targeted case management, and therapeutic behavioral services.

The code mix indicates a broad behavioral health service line with heavy emphasis on direct psychotherapy and case management: large volumes of 90837 (long psychotherapy), 90832/90834 (shorter psychotherapy sessions), and 90887 (family/caregiver explanations) show a dominant outpatient psychotherapy footprint, while high T2023 volume points to substantial targeted case management work. The presence of H2019, H0038, H2015, and T1040 signals that PATHWAYS also delivers structured behavioral and community support services, peer supports, and certified community behavioral health clinic per-diem services, consistent with a multi-modal community mental health center.

PATHWAYS ranks as a major in-state provider for many high-volume codes: 90837 ranks #9 of 1266 (99th percentile, described as an extreme outlier), T2023 ranks #9 of 525 (98th percentile, extreme outlier), and multiple psychotherapy and support codes (90832, 90834, 90791, 90792) are at or above the 97–99th percentiles. These rankings indicate PATHWAYS is a dominant or unusually large provider for core outpatient psychotherapy, case management, and evaluation services within Kentucky.

Several codes show notable scale but more typical in-state placement for certain residential and detox services: H0011 (acute detoxification) generates $5.2M (6.5% share) but ranks #24 of 72 (68th percentile), and T1040 (CCBHC per diem) is $2.5M (3.2% share) and ranks #2 of 4 (67th percentile). Those ranks suggest PATHWAYS provides some inpatient/residential and certified-clinic services at modest or concentrated levels compared with a few peers, rather than broadly across many competitors.

The provider’s claims volume profile emphasizes episode-based and time-unit billed services: extremely large claim counts for time-based codes—90832 (98K claims), H0038 (112.1K claims), and T1040 (362.5K claims)—alongside high counts for psychotherapy and E/M visits (e.g., 99213 with 81.2K claims) indicate an operational model built on frequent short encounters and recurring monthly or per-diem billing. This pattern aligns with community-based behavioral health delivery that relies on many short-duration visits, peer supports, and ongoing care management.

PATHWAYS has been enumerated since 2006-08-11 (~20 years ago), giving it long tenure in the Medicaid market; this duration supports the observed large market footprint and the high-ranking positions for multiple codes and suggests institutional stability and established referral channels within the state behavioral health system.

Several codes are flagged as statistical outliers or notably above typical state volume: 90837 and 90832 are labeled extreme outliers, 90834 and 90791/90792 also sit in the extreme outlier category, while codes like 90887, H0038, H2015, and 99213 are described as notably above typical volume. These designations reinforce that PATHWAYS’ scale for core psychotherapy, case management, and evaluation services is unusually large relative to most Kentucky providers and should be treated as a defining competitive characteristic.

Medicaid: Complete Services Breakdown

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

55 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	126,190	$110	$14.3M
T2023	Targeted case management; per month	40,090	$290	$11.7M
H2019	Therapeutic behavioral services, per 15 minutes	23,190	$270	$6.3M
90887	In this service, the provider interprets or explains the results of psychiatric exams, medical exams, other procedures, or information about the patient’s care to the patient’s family members or…	48,580	$120	$5.7M
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	98,020	$60	$5.6M
H0011	Alcohol and/or drug services; acute detoxification (hospital inpatient) per diem	21,870	$240	$5.2M
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	55,020	$90	$4.7M
H0038	Self‑help/peer services, per 15 minutes	112,060	$30	$3.1M
H2015	Comprehensive community support services, per 15 minutes	46,700	$60	$2.8M
T1040	Medicaid certified community behavioral health clinic services, per diem	362,500	$10	$2.5M

Showing 1–10 of 55

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 — 14 of 25 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

55 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0011	Alcohol and/or drug services; acute detoxification (hospital inpatient) per diem	24	70	7,180	$270	$6.8M
H2018	Psychosocial rehabilitation services, per diem	3	10	7,340	$820	$6.2M
H2034	Alcohol and/or drug abuse halfway house services, per diem	23	40	3,120	$220	$3M
S9485	Crisis intervention mental health services, per diem	9	10	7,960	$280	$2.5M
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	27	50	4,480	$220	$2.4M
T1040	Medicaid certified community behavioral health clinic services, per diem	2	10	303,880	$10	$2.4M
H0004	Behavioral health counseling and therapy, per 15 minutes	93	180	1,320	$220	$1.9M
H2019	Therapeutic behavioral services, per 15 minutes	4	50	820	$190	$1.7M
H0040	Assertive community treatment program, per diem	12	10	1,230	$670	$1.4M
H2020	Therapeutic behavioral services, per diem	41	130	1,730	$180	$1.2M

Showing 1–10 of 55

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	$95.4M
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