State of Missouri
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 8 procedure codes: H0001 at 3.2× median, 90837 at 1.7× median.
Statistical flags are not proof of wrongdoing. Some entities (government agencies, home care programs) may legitimately bill at high rates. Hospitals, government entities, and large care organizations may legitimately bill at higher rates due to patient acuity, overhead costs, or specialized services. Read our methodology.
Red Flags Explained
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Each flag represents a statistical test that identified unusual billing patterns. Here's what each flag on this provider means in plain English:
Rate Outlier
Rate Outlier means this provider charges above the 90th percentile for multiple different procedure codes simultaneously. While one high-cost code could reflect specialization, consistently high rates across many codes may indicate systematic overbilling.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $299.11 per claim for H0001 (Alcohol and/or drug assessment) — 3.2× the national median of $94.22.
Bills $120.12 per claim for H0002 (Behavioral health screening) — 3.1× the national median of $38.77.
Billing above the 90th percentile for 7 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Counselor, Addiction (Substance Use Disorder) Peers
Total spending distribution among 20 providers in this specialty
This provider's total spending of $271.6M is at the 90th percentile among 20 Counselor, Addiction (Substance Use Disorder) providers.
Above 90th percentile for this specialty — higher spending than 18 of 20 peers
Total Paid
$271.6M
$271,594,336
Total Claims
3.5M
Beneficiaries
1.0M
3.4 claims/patient
Avg Cost/Claim
$77
#292 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
State of Missouri is a Counselor, Addiction (Substance Use Disorder) provider based in Jefferson City, MO. From the 2018–2024 period, this provider received $271.6M in Medicaid payments across 3.5M claims.
Important Context
- ℹ️This is a government entity that may serve as a fiscal agent for large populations. Government providers often bill at high volumes due to the scale of public programs they administer.
Why This Matters
This provider received $271.6M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 33,949 Medicaid beneficiaries for a full year at average per-enrollee costs.
Monthly Spending Trend
Yearly Spending
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 30 distinct procedure codes. The top code (H2036 (Alcohol/drug treatment, per hour)) accounts for 22% of total spending.
$59.9M
174K claims
$344.50
$253.79
Alcohol/drug treatment, per hour
$59.9M
174K claims · 22.0%
$45.0M
475K claims
$94.84
$96.24
Comprehensive community support services, per 15 min
$45.0M
475K claims · 16.6%
$30.8M
446K claims
$68.95
$74.63
Behavioral health counseling & therapy, per 15 min
$30.8M
446K claims · 11.3%
$24.3M
616K claims
$39.41
$18.95
Alcohol/drug services; methadone administration
$24.3M
616K claims · 8.9%
$18.8M
514K claims
$36.64
$47.35
Alcohol and/or drug services, group counseling
$18.8M
514K claims · 6.9%
$18.1M
90K claims
$200.44
$129.75
Alcohol and/or drug abuse, intensive outpatient, per hour
$18.1M
90K claims · 6.6%
$14.2M
299K claims
$47.33
$137.86
Behavioral health day treatment, per hour
$14.2M
299K claims · 5.2%
$11.2M
24K claims
$459.87
$317.54
Alcohol and/or drug services, acute detoxification, per diem
$11.2M
24K claims · 4.1%
Alcohol and/or drug assessment
$9.9M
33K claims · 3.7%
$7.7M
377K claims
$20.45
$36.25
Behavioral health prevention education, per session
$7.7M
377K claims · 2.8%
RN services, per 15 minutes
$7.6M
168K claims · 2.8%
$5.3M
75K claims
$70.64
$1,437.23
Behavioral health; long-term residential, per diem
$5.3M
75K claims · 2.0%
$4.8M
71K claims
$67.05
$55.04
Self-help/peer services, per 15 minutes
$4.8M
71K claims · 1.8%
$3.6M
43K claims
$82.94
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$3.6M
43K claims · 1.3%
LPN/LVN services, per 15 minutes
$1.9M
54K claims · 0.7%
Behavioral health screening
$1.7M
14K claims · 0.6%
Psychotherapy, 60 minutes
$1.5M
10K claims · 0.6%
$1.4M
23K claims
$61.70
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$1.4M
23K claims · 0.5%
$700K
4,764 claims
$146.94
$74.09
Office/outpatient visit, high complexity
$700K
4,764 claims · 0.3%
$643K
3,100 claims
$207.50
$111.09
Office/outpatient visit, new patient, high complexity
$643K
3,100 claims · 0.2%
$562K
3,444 claims
$163.17
$84.03
Office/outpatient visit, new patient, mod-high complexity
$562K
3,444 claims · 0.2%
$354K
3,571 claims
$99.21
$99.21
Psychiatric diagnostic evaluation
$354K
3,571 claims · 0.1%
$332K
2,197 claims · 0.1%
$308K
5,711 claims
$53.97
$25.06
Office/outpatient visit, low complexity
$308K
5,711 claims · 0.1%
Psychotherapy, 30 minutes
$242K
3,306 claims · 0.1%
Psychotherapy, 45 minutes
$177K
1,561 claims · 0.1%
$163K
1,448 claims
$112.78
$57.85
Office/outpatient visit, new patient, low-mod complexity
$163K
1,448 claims · 0.1%
$143K
2,196 claims
$65.34
$109.04
Alcohol/drug services, family/couple counseling
$143K
2,196 claims · 0.1%
Group psychotherapy
$143K
8,765 claims · 0.1%
$112K
382 claims
$293.96
$369.55
Alcohol and/or drug services, sub-acute detoxification, per diem
$112K
382 claims · 0.0%
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