New River Valley Community Services
Cost Outlier
Billing over 3× the national median for specific procedure codes.
This provider bills $339.39 per claim for H0023 (Behavioral health outreach service, per 15 minutes), which is 6.3× the national median of $53.97.
Rate Outlier
Billing above the 90th percentile across multiple procedure codes simultaneously.
Billing above the 90th percentile for 7 procedure codes: H0023 at 6.3× median, H0039 at 11.8× median.
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.
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
Bills $339.39 per claim for H0023 (Behavioral health outreach service, per 15 minutes) — 6.3× the national median of $53.97.
Bills $1,563.84 per claim for H0039 (Assertive community treatment, per diem) — 11.8× the national median of $132.62.
Bills $345.03 per claim for T1017 (Targeted case management, per 15 min) — 5.0× the national median of $69.56.
Billing above the 90th percentile for 5 procedure codes simultaneously.
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 $193.8M is at the 50th percentile among 28 Clinic/Center Mental Health (Including Community Mental Health Center) providers.
Total Paid
$193.8M
$193,801,440
Total Claims
931K
Beneficiaries
418K
2.2 claims/patient
Avg Cost/Claim
$208
#480 of 618K providers by total spending(top <0.1%)
🔍 Analysis
Provider Overview
New River Valley Community Services is a Clinic/Center Mental Health (Including Community Mental Health Center) provider based in Blacksburg, VA. From the 2018–2024 period, this provider received $193.8M in Medicaid payments across 931K claims.
Why This Matters
This provider received $193.8M in taxpayer-funded Medicaid payments — enough to fund healthcare for approximately 24,225 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 35% of total spending.
$67.7M
199K claims
$339.39
$53.97
Behavioral health outreach service, per 15 minutes
$67.7M
199K claims · 34.9%
$30.5M
102K claims
$297.65
$1,051.57
Residential care, NOS; per diem
$30.5M
102K claims · 15.7%
$14.2M
9K claims
$1,563.84
$132.62
Assertive community treatment, per diem
$14.2M
9K claims · 7.3%
$13.4M
45K claims
$298.08
$336.31
Community-based wrap-around services, per diem
$13.4M
45K claims · 6.9%
$12.6M
63K claims
$200.02
$266.41
Assertive community treatment, face-to-face, per 15 minutes
$12.6M
63K claims · 6.5%
Targeted case management, per 15 min
$10.2M
29K claims · 5.2%
Psychotherapy, 60 minutes
$5.4M
48K claims · 2.8%
$4.5M
47K claims
$94.74
$148.53
Mental health partial hospitalization, treatment, per hour
$4.5M
47K claims · 2.3%
$4.4M
100K claims
$44.21
$91.63
Psychosocial rehabilitation services, per 15 min
$4.4M
100K claims · 2.3%
$3.8M
6K claims
$602.21
$215.80
Crisis intervention service, per 15 minutes
$3.8M
6K claims · 2.0%
$2.8M
27K claims
$102.84
$85.02
Mental health services, not otherwise specified
$2.8M
27K claims · 1.5%
$2.3M
6K claims
$360.29
$369.55
Alcohol and/or drug services, sub-acute detoxification, per diem
$2.3M
6K claims · 1.2%
$2.3M
20K claims
$113.10
$321.53
Comprehensive community support services, per 15 min
$2.3M
20K claims · 1.2%
$1.9M
10K claims
$187.20
$137.86
Behavioral health day treatment, per hour
$1.9M
10K claims · 1.0%
$1.7M
24K claims
$72.43
$53.41
Office/outpatient visit, est. patient, mod-high complexity
$1.7M
24K claims · 0.9%
$1.7M
2K claims
$757.32
$392.63
Psychosocial rehabilitation services, per diem
$1.7M
2K claims · 0.9%
Case management, per month
$1.7M
13K claims · 0.9%
$1.4M
7K claims
$187.65
$76.05
Community psychiatric supportive treatment, per 15 min
$1.4M
7K claims · 0.7%
$1.4M
5K claims
$290.84
$84.12
Therapeutic behavioral services, per 15 min
$1.4M
5K claims · 0.7%
$1.3M
18K claims
$73.30
$150.51
Day habilitation, waiver; per 15 min
$1.3M
18K claims · 0.7%
$1.1M
4K claims
$299.66
$300.13
Community transition, waiver; per service
$1.1M
4K claims · 0.6%
$1.1M
5K claims
$233.14
$43.10
Alcohol and/or drug services, case management
$1.1M
5K claims · 0.6%
Psychiatric diagnostic evaluation
$857K
7K claims · 0.4%
$807K
18K claims
$43.86
$37.81
Office/outpatient visit, est. patient, low-mod complexity
$807K
18K claims · 0.4%
$578K
36K claims
$16.06
$21.70
Non-emergency transport; encounter/trip
$578K
36K claims · 0.3%
$554K
580 claims
$954.64
$501.33
Crisis intervention mental health services, per diem
$554K
580 claims · 0.3%
$400K
6K claims
$71.76
$80.64
Mental health service plan development
$400K
6K claims · 0.2%
Psychotherapy, 45 minutes
$367K
4K claims · 0.2%
$335K
2K claims
$147.83
$108.91
Psychiatric diagnostic evaluation with medical services
$335K
2K claims · 0.2%
$325K
11K claims
$28.81
$21.33
Non-invasive prenatal screening, fetal chromosomal abnormalities
$325K
11K claims · 0.2%
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