Total Paid
$1.6M
$1,610,005
Total Claims
46K
Beneficiaries
5,331
8.5 claims/patient
Avg Cost/Claim
$35
🔍 Analysis
Provider Overview
is a Medicaid provider based in Unknown location. From 2020-11 through 2023-02, this provider received $1.6M in Medicaid payments across 46K claims serving 5K beneficiaries, billing 7 distinct procedure codes.
Key Findings
- 📊79% of billing is concentrated in 90876 (90876), indicating significant specialization in this service.
- 📊Spending grew 909% from $145K in 2020 to $1.5M in 2021.
- 📊Saw a 10.1× spike in 2021 ($145K → $1.5M), a sharp year-over-year increase.
- 📊Billing stopped in 2023-02, suggesting this provider is no longer active in Medicaid. Abrupt cessation of billing can be a risk indicator.
Why This Matters
This provider received $1.6M in Medicaid payments. While not among the largest billers, unusual patterns in providers of this size can still indicate systemic issues worth monitoring.
Yearly Spending
Procedure Breakdown
Cost per claim compared to national benchmarks
This provider bills for 7 distinct procedure codes. The top code (90876) accounts for 79% of total spending.
$1.3M
15K claims · 78.5%
$188K
15K claims
$12.46
$15.37
Telehealth originating site facility fee
$188K
15K claims · 11.7%
$158K
15K claims
$10.86
$12.93
Office/outpatient visit, minimal complexity
$158K
15K claims · 9.8%
$0
478 claims
$0.00
$38.83
Psychotherapy, 30 min, add-on to E/M service
$0
478 claims · 0.0%
$0
352 claims
$0.00
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$0
352 claims · 0.0%
$0
137 claims
$0.00
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$0
137 claims · 0.0%
$0
162 claims · 0.0%