Is CPC BEHAVIORAL HEALTHCARE flagged for Medicaid fraud?

CPC BEHAVIORAL HEALTHCARE (NPI: 1821537093) has not been flagged by our statistical fraud detection tests. Their billing patterns fall within normal ranges for their specialty.

How much does CPC BEHAVIORAL HEALTHCARE bill Medicaid?

CPC BEHAVIORAL HEALTHCARE received $0.1B in total Medicaid payments from 2018-2024, based on HHS billing records. They are classified as a Community/Behavioral Health provider. Located in RED BANK, NJ.

What is NPI 1821537093?

NPI 1821537093 is the National Provider Identifier for CPC BEHAVIORAL HEALTHCARE. They are a Community/Behavioral Health provider based in RED BANK, NJ. This NPI is registered with the CMS NPI Registry.

⚖️ Compare 🖨️ Print Report

CPC BEHAVIORAL HEALTHCARE

Community/Behavioral Health·RED BANK, NJ·NPI: 1821537093Share

Compared to Community/Behavioral Health Peers

Total spending distribution among 218 providers in this specialty

P25MedianP75P90

This provider's total spending of $80.7M is at the 50th percentile among 218 Community/Behavioral Health providers.

Active Billing Period:2018-01→2024-12(84 months)

Total Paid

$80.7M

$80,660,185

Total Claims

569K

Beneficiaries

404K

1.4 claims/patient

Avg Cost/Claim

$142

Monthly Spending Trend

Yearly Spending

2018

$9.7M

-4%

2019

$9.3M

+17%

2020

$10.9M

+13%

2021

$12.3M

+4%

2022

$12.9M

+3%

2023

$13.3M

-8%

2024

$12.3M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 42 distinct procedure codes. The top code (T1041 (Medicaid CCBHC services, per diem)) accounts for 100% of total spending.

ProcedureTotalYour Cost/ClaimNational Medianvs MedianPercentile

T1041Medicaid CCBHC services, per diemSee all providers →

$80.7M

112K claims

$720.56

$913.47

0.8×

Normal range

T1041Normal range

Medicaid CCBHC services, per diem

$80.7M

112K claims · 100.0%

Your Cost: $720.56/claim|Median: $913.47

0.8× median

T1023Screening to determine appropriateness of consideration for programSee all providers →

7,439 claims

$0.00

$106.70

—

Normal range

T1023Normal range

Screening to determine appropriateness of consideration for program

7,439 claims · 0.0%

Your Cost: $0.00/claim|Median: $106.70

99213Office/outpatient visit, est. patient, low-mod complexitySee all providers →

29K claims

$0.00

$37.81

—

Normal range

99213Normal range

Office/outpatient visit, est. patient, low-mod complexity

29K claims · 0.0%

Your Cost: $0.00/claim|Median: $37.81

G0396Alcohol/substance abuse structured assessment, 15-30 minutesSee all providers →

4,322 claims

$0.00

$40.58

—

Normal range

G0396Normal range

Alcohol/substance abuse structured assessment, 15-30 minutes

4,322 claims · 0.0%

Your Cost: $0.00/claim|Median: $40.58

H2000Comprehensive multidisciplinary evaluationSee all providers →

7,748 claims

$0.00

$114.71

—

Normal range

H2000Normal range

Comprehensive multidisciplinary evaluation

7,748 claims · 0.0%

Your Cost: $0.00/claim|Median: $114.71

98967 See all providers →

1,591 claims

$0.00

$18.97

—

Normal range

98967Normal range

1,591 claims · 0.0%

Your Cost: $0.00/claim|Median: $18.97

H0001Alcohol and/or drug assessmentSee all providers →

181 claims

$0.00

$94.22

—

Normal range

H0001Normal range

Alcohol and/or drug assessment

181 claims · 0.0%

Your Cost: $0.00/claim|Median: $94.22

H0006Alcohol and/or drug services, case managementSee all providers →

983 claims

$0.00

$43.10

—

Normal range

H0006Normal range

Alcohol and/or drug services, case management

983 claims · 0.0%

Your Cost: $0.00/claim|Median: $43.10

T1007Alcohol/drug services, treatment plan reviewSee all providers →

909 claims

$0.00

$64.10

—

Normal range

T1007Normal range

Alcohol/drug services, treatment plan review

909 claims · 0.0%

Your Cost: $0.00/claim|Median: $64.10

T1017Targeted case management, per 15 minSee all providers →

73K claims

$0.00

$69.56

—

Normal range

T1017Normal range

Targeted case management, per 15 min

73K claims · 0.0%

Your Cost: $0.00/claim|Median: $69.56

H0003 See all providers →

11K claims

$0.00

$13.38

—

Normal range

H0003Normal range

11K claims · 0.0%

Your Cost: $0.00/claim|Median: $13.38

3085F See all providers →

7,666 claims

$0.00

$0.85

—

Normal range

3085FNormal range

7,666 claims · 0.0%

Your Cost: $0.00/claim|Median: $0.85

90834Psychotherapy, 45 minutesSee all providers →

69K claims

$0.00

$63.65

—

Normal range

90834Normal range

Psychotherapy, 45 minutes

69K claims · 0.0%

Your Cost: $0.00/claim|Median: $63.65

96127Brief emotional/behavioral assessment, per standardized instrumentSee all providers →

5,632 claims

$0.00

$3.67

—

Normal range

96127Normal range

Brief emotional/behavioral assessment, per standardized instrument

5,632 claims · 0.0%

Your Cost: $0.00/claim|Median: $3.67

G0176Activity therapy (group), per sessionSee all providers →

172 claims

$0.00

$85.09

—

Normal range

G0176Normal range

Activity therapy (group), per session

172 claims · 0.0%

Your Cost: $0.00/claim|Median: $85.09

H0031Mental health assessment by non-physicianSee all providers →

1,327 claims

$0.00

$96.18

—

Normal range

H0031Normal range

Mental health assessment by non-physician

1,327 claims · 0.0%

Your Cost: $0.00/claim|Median: $96.18

99212Office/outpatient visit, low complexitySee all providers →

4,024 claims

$0.00

$25.06

—

Normal range

99212Normal range

Office/outpatient visit, low complexity

4,024 claims · 0.0%

Your Cost: $0.00/claim|Median: $25.06

H0035Mental health partial hospitalization, treatment, per hourSee all providers →

31K claims

$0.00

$148.53

—

Normal range

H0035Normal range

Mental health partial hospitalization, treatment, per hour

31K claims · 0.0%

Your Cost: $0.00/claim|Median: $148.53

98968 See all providers →

108 claims

$0.00

$28.39

—

Normal range

98968Normal range

108 claims · 0.0%

Your Cost: $0.00/claim|Median: $28.39

99408 See all providers →

62 claims

$0.00

$9.32

—

Normal range

99408Normal range

62 claims · 0.0%

Your Cost: $0.00/claim|Median: $9.32

99441Telephone E/M by physician, 5-10 minSee all providers →

6,319 claims

$0.00

$13.30

—

Normal range

99441Normal range

Telephone E/M by physician, 5-10 min

6,319 claims · 0.0%

Your Cost: $0.00/claim|Median: $13.30

H0032Mental health service plan developmentSee all providers →

21K claims

$0.00

$80.64

—

Normal range

H0032Normal range

Mental health service plan development

21K claims · 0.0%

Your Cost: $0.00/claim|Median: $80.64

T1012Alcohol/drug services, skills developmentSee all providers →

5,943 claims

$0.00

$40.78

—

Normal range

T1012Normal range

Alcohol/drug services, skills development

5,943 claims · 0.0%

Your Cost: $0.00/claim|Median: $40.78

99406 See all providers →

55 claims

$0.00

$6.53

—

Normal range

99406Normal range

55 claims · 0.0%

Your Cost: $0.00/claim|Median: $6.53

90791Psychiatric diagnostic evaluationSee all providers →

5,313 claims

$0.00

$99.21

—

Normal range

90791Normal range

Psychiatric diagnostic evaluation

5,313 claims · 0.0%

Your Cost: $0.00/claim|Median: $99.21

90833Psychotherapy, 30 min, add-on to E/M serviceSee all providers →

1,167 claims

$0.00

$38.83

—

Normal range

90833Normal range

Psychotherapy, 30 min, add-on to E/M service

1,167 claims · 0.0%

Your Cost: $0.00/claim|Median: $38.83

H0030 See all providers →

901 claims

$0.00

$20.62

—

Normal range

H0030Normal range

901 claims · 0.0%

Your Cost: $0.00/claim|Median: $20.62

H0015Alcohol and/or drug abuse, intensive outpatient, per hourSee all providers →

19K claims

$0.00

$129.75

—

Normal range

H0015Normal range

Alcohol and/or drug abuse, intensive outpatient, per hour

19K claims · 0.0%

Your Cost: $0.00/claim|Median: $129.75

99215Office/outpatient visit, high complexitySee all providers →

2,252 claims

$0.00

$74.09

—

Normal range

99215Normal range

Office/outpatient visit, high complexity

2,252 claims · 0.0%

Your Cost: $0.00/claim|Median: $74.09

90853Group psychotherapySee all providers →

7,346 claims

$0.00

$25.02

—

Normal range

90853Normal range

Group psychotherapy

7,346 claims · 0.0%

Your Cost: $0.00/claim|Median: $25.02

H0005Alcohol and/or drug services, group counselingSee all providers →

727 claims

$0.00

$47.35

—

Normal range

H0005Normal range

Alcohol and/or drug services, group counseling

727 claims · 0.0%

Your Cost: $0.00/claim|Median: $47.35

H2023Supported employment, per 15 minSee all providers →

5,680 claims

$0.00

$103.94

—

Normal range

H2023Normal range

Supported employment, per 15 min

5,680 claims · 0.0%

Your Cost: $0.00/claim|Median: $103.94

98966 See all providers →

80K claims

$0.00

$6.84

—

Normal range

98966Normal range

80K claims · 0.0%

Your Cost: $0.00/claim|Median: $6.84

99211Office/outpatient visit, minimal complexitySee all providers →

12 claims

$0.00

$12.93

—

Normal range

99211Normal range

Office/outpatient visit, minimal complexity

12 claims · 0.0%

Your Cost: $0.00/claim|Median: $12.93

90792Psychiatric diagnostic evaluation with medical servicesSee all providers →

4,712 claims

$0.00

$108.91

—

Normal range

90792Normal range

Psychiatric diagnostic evaluation with medical services

4,712 claims · 0.0%

Your Cost: $0.00/claim|Median: $108.91

H2011Crisis intervention service, per 15 minutesSee all providers →

194 claims

$0.00

$215.80

—

Normal range

H2011Normal range

Crisis intervention service, per 15 minutes

194 claims · 0.0%

Your Cost: $0.00/claim|Median: $215.80

90847Family psychotherapy with patient, 50 minSee all providers →

955 claims

$0.00

$77.33

—

Normal range

90847Normal range

Family psychotherapy with patient, 50 min

955 claims · 0.0%

Your Cost: $0.00/claim|Median: $77.33

99214Office/outpatient visit, est. patient, mod-high complexitySee all providers →

33K claims

$0.00

$53.41

—

Normal range

99214Normal range

Office/outpatient visit, est. patient, mod-high complexity

33K claims · 0.0%

Your Cost: $0.00/claim|Median: $53.41

99368 See all providers →

15 claims

$0.00

$19.67

—

Normal range

99368Normal range

15 claims · 0.0%

Your Cost: $0.00/claim|Median: $19.67

96156 See all providers →

2,887 claims

$0.00

$22.36

—

Normal range

96156Normal range

2,887 claims · 0.0%

Your Cost: $0.00/claim|Median: $22.36

T1502Administration of oral, intramuscular, or subcutaneous medicationSee all providers →

4,289 claims

$0.00

$7.86

—

Normal range

T1502Normal range

Administration of oral, intramuscular, or subcutaneous medication

4,289 claims · 0.0%

Your Cost: $0.00/claim|Median: $7.86

96150Health behavior assessment, initialSee all providers →

43 claims

$0.00

$17.83

—

Normal range

96150Normal range

Health behavior assessment, initial

43 claims · 0.0%

Your Cost: $0.00/claim|Median: $17.83

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