Horizon Behavioral Health
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $333.88 per claim for H0023 (Behavioral health outreach service, per 15 minutes), which is 6.2× the national median of $53.97.
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.
These flags are statistical indicators only. Many flagged providers have legitimate explanations for their billing patterns. Learn more about our methodology.
Risk Assessment
Bills $333.88 per claim for H0023 (Behavioral health outreach service, per 15 minutes) — 6.2× the national median of $53.97.
Bills $335.72 per claim for T1017 (Targeted case management, per 15 min) — 4.8× the national median of $69.56.
Bills $327.03 per claim for H2019 (Therapeutic behavioral services, per 15 min) — 3.9× the national median of $84.12.
Billing above the 90th percentile for 5 procedure codes simultaneously.
This is a statistical summary, not an accusation. See our methodology.
Compared to Community/Behavioral Health Peers
Total spending distribution among 218 providers in this specialty
This provider's total spending of $138.0M is at the 50th percentile among 218 Community/Behavioral Health providers.
Total Paid
$138.0M
$138,041,259
Total Claims
726K
Beneficiaries
483K
1.5 claims/patient
Avg Cost/Claim
$190
#806 of 618K providers by total spending(top 0.1%)
🔍 Analysis
Provider Overview
Horizon Behavioral Health is a Community/Behavioral Health provider based in Lynchburg, VA. From the 2018–2024 period, this provider received $138.0M in Medicaid payments across 726K claims.
Why This Matters
This provider received $138.0M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 17,255 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 (H0023 (Behavioral health outreach service, per 15 minutes)) accounts for 46% of total spending.
$63.7M
191K claims
$333.88
$53.97
Behavioral health outreach service, per 15 minutes
$63.7M
191K claims · 46.1%
Targeted case management, per 15 min
$17.9M
53K claims · 12.9%
Psychotherapy, 60 minutes
$12.5M
114K claims · 9.0%
$8.3M
85K claims
$98.17
$148.53
Mental health partial hospitalization, treatment, per hour
$8.3M
85K claims · 6.0%
$4.4M
13K claims
$327.03
$84.12
Therapeutic behavioral services, per 15 min
$4.4M
13K claims · 3.2%
$3.9M
19K claims
$207.19
$266.41
Assertive community treatment, face-to-face, per 15 minutes
$3.9M
19K claims · 2.8%
$3.4M
14K claims
$236.18
$129.75
Alcohol and/or drug abuse, intensive outpatient, per hour
$3.4M
14K claims · 2.5%
$3.3M
5K claims
$663.74
$215.80
Crisis intervention service, per 15 minutes
$3.3M
5K claims · 2.4%
$3.3M
52K claims
$64.64
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$3.3M
52K claims · 2.4%
$2.5M
6K claims
$391.98
$132.62
Assertive community treatment, per diem
$2.5M
6K claims · 1.8%
$2.2M
8K claims
$287.03
$300.13
Community transition, waiver; per service
$2.2M
8K claims · 1.6%
$2.1M
9K claims
$226.29
$76.05
Community psychiatric supportive treatment, per 15 min
$2.1M
9K claims · 1.5%
$1.9M
15K claims
$124.92
$99.21
Psychiatric diagnostic evaluation
$1.9M
15K claims · 1.4%
$1.6M
40K claims
$40.33
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$1.6M
40K claims · 1.2%
$1.6M
16K claims
$99.56
$74.09
Office/outpatient visit, high complexity
$1.6M
16K claims · 1.2%
Psychotherapy, 45 minutes
$1.1M
15K claims · 0.8%
$1.0M
21K claims
$50.28
$91.63
Psychosocial rehabilitation services, per 15 min
$1.0M
21K claims · 0.7%
$719K
3K claims
$222.00
$227.82
Multisystemic therapy for juveniles, per 15 minutes
$719K
3K claims · 0.5%
Psychotherapy, 30 minutes
$684K
12K claims · 0.5%
$630K
3K claims
$223.82
$43.10
Alcohol and/or drug services, case management
$630K
3K claims · 0.5%
$280K
2K claims
$168.63
$164.03
Alcohol and/or drug abuse halfway house services, per hour
$280K
2K claims · 0.2%
$215K
407 claims
$528.05
$625.59
Family stabilization services, per 15 minutes
$215K
407 claims · 0.2%
$113K
1K claims
$87.37
$85.02
Mental health services, not otherwise specified
$113K
1K claims · 0.1%
$105K
12K claims
$8.66
$9.56
Therapeutic injection, subcutaneous/intramuscular
$105K
12K claims · 0.1%
$91K
2K claims
$45.31
$74.63
Behavioral health counseling & therapy, per 15 min
$91K
2K claims · 0.1%
Group psychotherapy
$91K
4K claims · 0.1%
$61K
296 claims
$204.61
$137.85
Other specified case management service, per 15 minutes
$61K
296 claims · 0.0%
$56K
1K claims
$49.16
$80.64
Mental health service plan development
$56K
1K claims · 0.0%
$48K
4K claims
$12.31
$12.93
Office/outpatient visit, minimal complexity
$48K
4K claims · 0.0%
$27K
311 claims
$88.42
$77.33
Family psychotherapy with patient, 50 min
$27K
311 claims · 0.0%
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