Statistical flags indicate unusual patterns — not proof of fraud or wrongdoing. Read our methodology

Valley Behavioral Health Incorporated

Psychiatry & Neurology Psychiatry·Salt Lake City, UT·NPI: 1932166980SharePrint Report
View on Risk Watchlist →

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:

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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

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Bills $334.57 per claim for 90791 (Psychiatric diagnostic evaluation) — 3.4× the national median of $99.21.

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Bills $368.31 per claim for H2027 (Psychoeducational service, per 15 minutes) — 4.5× the national median of $82.72.

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Bills $877.28 per claim for H0040 (Assertive community treatment, face-to-face, per 15 minutes) — 3.3× the national median of $266.41.

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Billing in the top 1% nationally for 3 procedure codes: 90791, 99309, 99308.

This is a statistical summary, not an accusation. See our methodology.

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

Total Paid

$293.4M

$293,427,653

Total Claims

2.7M

Beneficiaries

713K

3.8 claims/patient

Avg Cost/Claim

$109

#254 of 618K providers by total spending(top <0.1%)

🔍 Analysis

Provider Overview

Valley Behavioral Health Incorporated is a Psychiatry & Neurology Psychiatry provider based in Salt Lake City, UT. From the 2018–2024 period, this provider received $293.4M in Medicaid payments across 2.7M claims.

Why This Matters

This provider received $293.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 36,678 Medicaid beneficiaries for a full year at average per-enrollee costs.

↓ 55% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$58.0M
-1%
2019
$57.2M
+4%
2020
$59.7M
-39%
2021
$36.7M
-22%
2022
$28.6M
-5%
2023
$27.1M
-3%
2024
$26.2M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 30 distinct procedure codes. The top code (H2016 (Comprehensive community support services, per 15 min)) accounts for 14% of total spending.

H2016Normal range

Comprehensive community support services, per 15 min

$39.6M

387K claims · 13.5%

Your Cost: $102.37/claim|Median: $321.53
0.3× median
90837Top 5%

Psychotherapy, 60 minutes

$36.9M

217K claims · 12.6%

Your Cost: $169.78/claim|Median: $85.66
2.0× median
H2017Normal range

Psychosocial rehabilitation services, per 15 min

$25.5M

274K claims · 8.7%

Your Cost: $93.00/claim|Median: $91.63
1.0× median
T1017Normal range

Targeted case management, per 15 min

$24.6M

340K claims · 8.4%

Your Cost: $72.38/claim|Median: $69.56
1.0× median
H0018Normal range

Behavioral health; short-term residential, per diem

$23.1M

168K claims · 7.9%

Your Cost: $137.26/claim|Median: $467.51
0.3× median
H2019Top 25%

Therapeutic behavioral services, per 15 min

$20.9M

146K claims · 7.1%

Your Cost: $143.39/claim|Median: $84.12
1.7× median
H2013Normal range

Psychiatric health facility service, per diem

$12.9M

30K claims · 4.4%

Your Cost: $427.39/claim|Median: $841.93
0.5× median
99214Top 5%

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

$12.5M

99K claims · 4.3%

Your Cost: $126.71/claim|Median: $53.41
2.4× median
90791Top 1%

Psychiatric diagnostic evaluation

$12.3M

37K claims · 4.2%

Your Cost: $334.57/claim|Median: $99.21
3.4× median
H2014Normal range

Skills training & development, per 15 min

$9.5M

90K claims · 3.2%

Your Cost: $105.75/claim|Median: $83.88
1.3× median
H0038Top 25%

Self-help/peer services, per 15 minutes

$9.4M

81K claims · 3.2%

Your Cost: $115.28/claim|Median: $55.04
2.1× median
80307Normal range

Drug test, presumptive, by chemistry analyzers

$7.8M

172K claims · 2.7%

Your Cost: $45.55/claim|Median: $35.43
1.3× median
90853Top 25%

Group psychotherapy

$7.7M

140K claims · 2.6%

Your Cost: $54.79/claim|Median: $25.02
2.2× median
H2027Top 25%

Psychoeducational service, per 15 minutes

$7.6M

21K claims · 2.6%

Your Cost: $368.31/claim|Median: $82.72
4.5× median
T1001Normal range

Nursing assessment/evaluation, per visit

$6.4M

86K claims · 2.2%

Your Cost: $74.69/claim|Median: $49.05
1.5× median
G0481Normal range

Drug test, definitive, 8-14 drug classes

$5.0M

101K claims · 1.7%

Your Cost: $49.73/claim|Median: $64.72
0.8× median
90834Top 5%

Psychotherapy, 45 minutes

$3.9M

27K claims · 1.3%

Your Cost: $145.56/claim|Median: $63.65
2.3× median
H0040Normal range

Assertive community treatment, face-to-face, per 15 minutes

$3.4M

4K claims · 1.2%

Your Cost: $877.28/claim|Median: $266.41
3.3× median
99213Top 5%

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

$3.3M

24K claims · 1.1%

Your Cost: $141.35/claim|Median: $37.81
3.7× median
H0046Top 25%

Mental health services, not otherwise specified

$3.3M

19K claims · 1.1%

Your Cost: $175.40/claim|Median: $85.02
2.1× median
S5150Normal range

Unskilled respite care, per 15 min

$3.1M

34K claims · 1.1%

Your Cost: $92.38/claim|Median: $84.46
1.1× median
90847Top 5%

Family psychotherapy with patient, 50 min

$3.0M

13K claims · 1.0%

Your Cost: $230.39/claim|Median: $77.33
3.0× median
H2036Normal range

Alcohol/drug treatment, per hour

$2.9M

16K claims · 1.0%

Your Cost: $183.16/claim|Median: $253.79
0.7× median
90832Top 10%

Psychotherapy, 30 minutes

$2.8M

31K claims · 1.0%

Your Cost: $91.98/claim|Median: $41.28
2.2× median
H0006Normal range

Alcohol and/or drug services, case management

$1.8M

45K claims · 0.6%

Your Cost: $40.76/claim|Median: $43.10
0.9× median
99309Top 1%

Nursing facility care, subsequent, low complexity

$1.3M

11K claims · 0.4%

Your Cost: $111.63/claim|Median: $14.00
8.0× median
90792Top 25%

Psychiatric diagnostic evaluation with medical services

$572K

3K claims · 0.2%

Your Cost: $201.31/claim|Median: $108.91
1.9× median
97153Normal range

Adaptive behavior treatment by protocol, per 15 min

$434K

3K claims · 0.1%

Your Cost: $124.81/claim|Median: $167.38
0.8× median
99308Top 1%

Nursing facility care, subsequent, straightforward

$341K

3K claims · 0.1%

Your Cost: $129.67/claim|Median: $9.79
13.3× median
96372Top 10%

Therapeutic injection, subcutaneous/intramuscular

$261K

10K claims · 0.1%

Your Cost: $25.44/claim|Median: $9.56
2.7× median

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