Centerstone of Tennessee Inc.
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $146.79 per claim for S0280 (Medical home program, comprehensive care management), which is 3.0× the national median of $48.38.
High Cost Per Claim
Average payment per claim is much higher than peers billing the same procedures.
High Claims Per Patient
Filing an unusually high number of claims per beneficiary compared to peers.
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:
Cost Outlier
Cost Outlier means this provider charges significantly more per claim than other providers billing the same procedure codes. This could indicate upcoding, inflated charges, or specialized services that justify higher costs.
High Cost Per Claim
High Cost Per Claim means each individual claim from this provider costs significantly more than what other providers charge for the same services. This could indicate upcoding (billing for more expensive services than provided) or legitimate specialized care.
High Claims Per Patient
High Claims Per Patient means this provider files an unusually high number of claims per individual patient. This could indicate legitimate intensive treatment or a pattern of billing for services not actually rendered.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $146.79 per claim for S0280 (Medical home program, comprehensive care management) — 3.0× the national median of $48.38.
Bills $1,967.60 per claim for H2020 (Day habilitation, waiver, per 15 minutes) — 13.7× the national median of $144.05.
Bills $674.17 per claim for S5145 (Foster care, therapeutic, child, per diem) — 3.1× the national median of $216.31.
This is a statistical summary, not an accusation. See our methodology.
Compared to Clinic/Center Mental Health (Including Community Mental Health Center) Peers
Total spending distribution among 28 providers in this specialty
This provider's total spending of $363.8M is at the 75th percentile among 28 Clinic/Center Mental Health (Including Community Mental Health Center) providers.
Total Paid
$363.8M
$363,759,741
Total Claims
4.6M
Beneficiaries
2.3M
2.0 claims/patient
Avg Cost/Claim
$79
#183 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
Centerstone of Tennessee Inc. is a Clinic/Center Mental Health (Including Community Mental Health Center) provider based in Nashville, TN. From the 2018–2024 period, this provider received $363.8M in Medicaid payments across 4.6M claims.
Why This Matters
This provider received $363.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 45,469 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 (S0280 (Medical home program, comprehensive care management)) accounts for 19% of total spending.
$67.9M
462K claims
$146.79
$48.38
Medical home program, comprehensive care management
$67.9M
462K claims · 18.7%
Supported housing, per diem
$55.9M
582K claims · 15.4%
Psychotherapy, 60 minutes
$48.4M
463K claims · 13.3%
Psychotherapy, 45 minutes
$46.2M
616K claims · 12.7%
$31.0M
192K claims
$161.06
$225.50
Community psychiatric supportive treatment program, per diem
$31.0M
192K claims · 8.5%
Psychotherapy, 30 minutes
$26.9M
477K claims · 7.4%
$15.2M
243K claims
$62.62
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$15.2M
243K claims · 4.2%
$12.4M
6K claims
$1,967.60
$144.05
Day habilitation, waiver, per 15 minutes
$12.4M
6K claims · 3.4%
$11.2M
255K claims
$44.08
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$11.2M
255K claims · 3.1%
$10.2M
225K claims
$45.30
$91.63
Psychosocial rehabilitation services, per 15 min
$10.2M
225K claims · 2.8%
$10.0M
86K claims
$116.73
$99.21
Psychiatric diagnostic evaluation
$10.0M
86K claims · 2.7%
$8.8M
43K claims
$201.97
$108.80
Coordinated care fee, maintenance period
$8.8M
43K claims · 2.4%
$8.4M
107K claims
$77.93
$392.63
Psychosocial rehabilitation services, per diem
$8.4M
107K claims · 2.3%
$3.0M
22K claims
$133.40
$108.91
Psychiatric diagnostic evaluation with medical services
$3.0M
22K claims · 0.8%
$2.5M
30K claims
$82.76
$77.33
Family psychotherapy with patient, 50 min
$2.5M
30K claims · 0.7%
$2.4M
14K claims
$170.06
$76.05
Community psychiatric supportive treatment, per 15 min
$2.4M
14K claims · 0.7%
$1.6M
2K claims
$674.17
$216.31
Foster care, therapeutic, child, per diem
$1.6M
2K claims · 0.4%
$910K
13K claims
$69.99
$76.61
Family psychotherapy without patient, 50 min
$910K
13K claims · 0.3%
Group psychotherapy
$194K
8K claims · 0.1%
$194K
4K claims
$43.83
$55.04
Self-help/peer services, per 15 minutes
$194K
4K claims · 0.1%
$161K
4K claims
$39.76
$25.06
Office/outpatient visit, low complexity
$161K
4K claims · 0.0%
$112K
5K claims
$20.92
$38.83
Psychotherapy, 30 min, add-on to E/M service
$112K
5K claims · 0.0%
$104K
1K claims
$86.13
$31.37
Oral medication administration, direct observation
$104K
1K claims · 0.0%
$56K
1K claims
$51.75
$74.09
Office/outpatient visit, high complexity
$56K
1K claims · 0.0%
$35K
2K claims
$15.67
$56.90
Medication training and management, per 15 min
$35K
2K claims · 0.0%
Case management, each 15 min
$31K
6K claims · 0.0%
$12K
4K claims
$3.09
$249.51
Crisis intervention mental health services, per hour
$12K
4K claims · 0.0%
$9K
89 claims
$95.51
$182.66
Alcohol or drug abuse services, prenatal
$9K
89 claims · 0.0%
$5K
348 claims
$14.66
$22.44
Telephone E/M by physician, 11-20 minutes
$5K
348 claims · 0.0%
$2K
2K claims · 0.0%
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