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

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

Potomac Case Management Services, Inc. (NPI 1982749701)

Field	Value
Entity Type	Organization
Organization	Potomac Case Management Services, Inc.
Address	324 E Antietam St
City	Hagerstown
State	MD
ZIP	21740
Taxonomy	Case Management Agency
NPI Enumerated	February 20, 2007

Payer Source	Total Paid
Medicaid	$28M
Medicare	$0

Key Findings

POTOMAC CASE MANAGEMENT SERVICES, INC. reports no Medicare billing on file and $28M in lifetime Medicaid revenue, making it effectively a Medicaid-focused operation rather than a dual-payer provider. The absence of Medicare activity suggests analyses of competitive standing and payer risk should be framed primarily around Medicaid program dynamics and state-level peers.

The provider’s Medicaid revenue is highly concentrated: the precomputed top 3 Medicaid codes by revenue account for 100.0% of this provider's total Medicaid revenue, with T1017 at $14.3M (51.0%), T1016 at $12.8M (45.6%), and H0031 at $951.1K (3.4%). This concentration indicates that a very small set of services drives virtually all reported Medicaid receipts.

The billing mix — dominated by T1017 (Targeted case management, each 15 minutes) and T1016 (Case management, each 15 minutes) with supplementary H0031 (Mental health assessment, by non-physician) — is consistent with an organization operating as a dedicated case management agency that also performs non-physician mental health assessments. These codes imply the business model centers on time-based case management encounters rather than procedure- or facility-based care.

T1016 is an outlier in the Maryland market: the provider reports 95.5K claims for T1016 generating $12.8M at $134 avg paid/claim and ranks #1 of 42 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code). That rank and the label “extreme outlier” indicate the provider is a dominant state-level supplier of time-based case management under this code and a focal point for peers and payers monitoring utilization.

T1017 represents the single largest revenue line at $14.3M from 71.2K claims and $201 avg paid/claim, yet it ranks #2 of 24 providers in-state (96th percentile; typical, unremarkable volume for this code). While revenue from T1017 is substantial in absolute terms, the rank and percentile suggest the provider’s T1017 volumes are high but not uniquely exceptional compared with a broader set of state providers.

H0031 is a small but identifiable component of the Medicaid mix, contributing $951.1K (3.4%) from 7K claims at $135 avg paid/claim and ranking #3 of 28 providers in-state (93th percentile; typical, unremarkable volume for this code). This indicates the provider offers mental health assessment services alongside core case management activity, but these assessments do not materially drive overall revenue.

The provider’s long tenure — NPI enumerated 2007-02-20 (~19 years ago) — signals an established operation with sustained Medicaid engagement; this longevity may reflect institutional capacity to deliver time-based case management at scale. For payers and analysts, the combination of long tenure and concentrated service lines suggests institutional specialization but also potential sensitivity to policy or rate changes that affect case management reimbursements.

From a competitive and risk perspective, the business is heavily dependent on case management reimbursements under T1017 and T1016 (which together compose the vast majority of Medicaid revenue). That operational concentration, coupled with no Medicare presence, means state-level policy shifts, prior authorization changes, or alterations to case management definitions or rates could have outsized impact on the provider’s financial profile and should be a focus for payer oversight and contract strategy.

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
T1017	Targeted case management, each 15 minutes	71,160	$200	$14.3M
T1016	Case management, each 15 minutes	95,470	$130	$12.8M
H0031	Mental health assessment, by non-physician	7,050	$140	$951.1K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maryland Distribution

Potomac Case Management Services, Inc. — 2 of 3 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maryland

Full comparison — all codes billed, vs. Maryland median

3 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1017	Targeted case management, each 15 minutes	2	20	6,750	$150	$2.8M
T1016	Case management, each 15 minutes	1	40	4,570	$140	$1.3M
H0031	Mental health assessment, by non-physician	3	30	120	$230	$1.1M

Nearby Providers

Other providers in the same ZIP code as Potomac Case Management Services, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Dr. David M. Vieth 2, P.C.	MD	General Practice Dentistry	$0	$77.8M
Phoenix Health Center LLC	MD	Methadone Clinic	$507.7K	$21.4M
Awakenings Recovery Center, LLC	MD	Substance Abuse Rehabilitation Facility	$0	$19.8M
Qualitycare Internet, LLP	MD	Mental Health Counselor	$0	$19.4M
Walnut Street Community Health Center, Inc.	MD	Federally Qualified Health Center (FQHC)	$0	$19.3M
Board Of Education Of Washington County	MD	Local Education Agency (LEA)	$0	$19.1M
Center For Pain Management, LLC	MD	Interventional Pain Medicine Physician	$0	$18.9M
Metro Treatment Of Maryland LP	MD	Community/Behavioral Health Agency	$361K	$16.6M
The Western Maryland Counseling Center	MD	Community/Behavioral Health Agency	$0	$16.5M
David Warrow	MD	Ophthalmology Physician	$15.1M	$8.3K

Potomac Case Management Services, Inc. — Billing Profile & Reimbursement Data

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Potomac Case Management Services, Inc. — Billing Profile & Reimbursement Data

Sign up for Potomac Case Management Services, Inc. — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References