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Spectrum Health Systems, INC

Clinic/Center, Rehabilitation, Substance Use Disorder·Worcester, MA·NPI: 1487608485Share

Compared to Clinic/Center, Rehabilitation, Substance Use Disorder Peers

Total spending distribution among 13 providers in this specialty

P25MedianP75P90

This provider's total spending of $187.4M is at the 99th percentile among 13 Clinic/Center, Rehabilitation, Substance Use Disorder providers.

Above 99th percentile for this specialty — higher spending than 12 of 13 peers

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

Total Paid

$187.4M

$187,394,553

Total Claims

7.5M

Beneficiaries

518K

14.4 claims/patient

Avg Cost/Claim

$25

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

🔍 Analysis

Provider Overview

Spectrum Health Systems, INC is a Clinic/Center, Rehabilitation, Substance Use Disorder provider based in Worcester, MA. From the 2018–2024 period, this provider received $187.4M in Medicaid payments across 7.5M claims.

Why This Matters

This provider received $187.4M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 23,424 Medicaid beneficiaries for a full year at average per-enrollee costs.

↑ 30% growthsince first billing year

Monthly Spending Trend

Yearly Spending

2018
$22.7M
+5%
2019
$23.7M
-3%
2020
$23.1M
-2%
2021
$22.7M
+18%
2022
$26.7M
+46%
2023
$39.0M
-25%
2024
$29.4M

Procedure Breakdown

Cost per claim compared to national benchmarks

This provider bills for 23 distinct procedure codes. The top code (H0020 (Alcohol/drug services; methadone administration)) accounts for 49% of total spending.

H0020Normal range

Alcohol/drug services; methadone administration

$92.1M

6.8M claims · 49.1%

Your Cost: $13.62/claim|Median: $18.95
0.7× median
G2067Normal range

Medication-assisted treatment, opioid use disorder, per month

$57.9M

414K claims · 30.9%

Your Cost: $139.82/claim|Median: $73.29
1.9× median
H0019Normal range

Behavioral health; residential, per diem

$15.7M

113K claims · 8.4%

Your Cost: $138.92/claim|Median: $357.16
0.4× median
H0010Normal range

Alcohol and/or drug services, sub-acute detoxification, per diem

$7.4M

22K claims · 3.9%

Your Cost: $333.90/claim|Median: $369.55
0.9× median
H0011Top 25%

Alcohol and/or drug services, acute detoxification, per diem

$6.4M

15K claims · 3.4%

Your Cost: $433.31/claim|Median: $317.54
1.4× median
H0004Normal range

Behavioral health counseling & therapy, per 15 min

$2.2M

41K claims · 1.2%

Your Cost: $54.60/claim|Median: $74.63
0.7× median
H0005Normal range

Alcohol and/or drug services, group counseling

$1.4M

47K claims · 0.7%

Your Cost: $29.70/claim|Median: $47.35
0.6× median
90791Normal range

Psychiatric diagnostic evaluation

$974K

8K claims · 0.5%

Your Cost: $122.30/claim|Median: $99.21
1.2× median
G2074Normal range

$930K

9K claims · 0.5%

Your Cost: $104.92/claim|Median: $82.20
1.3× median
G2078Normal range

$627K

20K claims · 0.3%

Your Cost: $32.13/claim|Median: $27.04
1.2× median
99213Top 25%

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

$593K

9K claims · 0.3%

Your Cost: $66.18/claim|Median: $37.81
1.8× median
99214Top 10%

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

$439K

4K claims · 0.2%

Your Cost: $100.73/claim|Median: $53.41
1.9× median
90837Normal range

Psychotherapy, 60 minutes

$221K

3K claims · 0.1%

Your Cost: $82.23/claim|Median: $85.66
1.0× median
G2076Normal range

$188K

1K claims · 0.1%

Your Cost: $143.74/claim|Median: $275.92
0.5× median
H2015Normal range

Comprehensive community support services, per 15 min

$165K

5K claims · 0.1%

Your Cost: $30.96/claim|Median: $96.24
0.3× median
90832Normal range

Psychotherapy, 30 minutes

$39K

1K claims · 0.0%

Your Cost: $37.47/claim|Median: $41.28
0.9× median
90853Normal range

Group psychotherapy

$28K

1K claims · 0.0%

Your Cost: $24.02/claim|Median: $25.02
1.0× median
90834Normal range

Psychotherapy, 45 minutes

$15K

194 claims · 0.0%

Your Cost: $76.49/claim|Median: $63.65
1.2× median
90882Normal range

Environmental intervention

$12K

544 claims · 0.0%

Your Cost: $21.55/claim|Median: $45.05
0.5× median
G2077Normal range

$3K

225 claims · 0.0%

Your Cost: $14.39/claim|Median: $38.98
0.4× median
H0015Normal range

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

$3K

34 claims · 0.0%

Your Cost: $73.60/claim|Median: $129.75
0.6× median
99203Top 25%

Office/outpatient visit, new patient, low-mod complexity

$2K

24 claims · 0.0%

Your Cost: $83.28/claim|Median: $57.85
1.4× median
G2080

$1K

442 claims · 0.0%

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