Agency
Toe River Health District
Toe River Health District was paid $1.30M by Medicaid between Jan 2018 and Dec 2024, across 43 billing codes. Its largest line is 99199, Unlisted special service, procedure or report — 73% of everything it billed.
33Billing provider infoTOE RIVER HEALTH DISTRICT
BAKERSVILLE, NC 28705
BAKERSVILLE, NC 28705
33aNPI1295864452assigned 03/05/2007
33bProvider typeCase Management Agency
28Total paid$1.30M
24GClaims199,677
24DCodes billed43
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Case Management Agency providers in North Carolina
Rank by total paid#110 of 195
Median peer was paid$2.05M
This provider vs. median0.6×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
Box 24A · Dates of service
Paid by month
Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider
By year, as a table
| Year | Claims | Paid | |
|---|---|---|---|
| 2018 | 5,668 | $99K | |
| 2019 | 5,748 | $102K | |
| 2020 | 1,836 | $26K | |
| 2021 | 23,734 | $170K | |
| 2022 | 49,056 | $274K | |
| 2023 | 46,789 | $257K | |
| 2024incomplete | 66,846 | $371K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| 99199 | Unlisted special service, procedure or report | 73% | 179,119 | 125,931 | $944K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | 6.8% | 1,375 | 1,156 | $88K |
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, minimal severity | 4.6% | 2,087 | 1,534 | $60K |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | 4.1% | 5,115 | 3,904 | $53K |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, straightforward | 3.7% | 953 | 766 | $48K |
| 99214 | Doctor's office visit, returning patient (more involved)Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity | 2.4% | 333 | 256 | $31K |
| 99394 | Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) | 1.4% | 223 | 189 | $18K |
| 90472 | Immunization administration, each additional vaccine (list separately) | <1% | 838 | 601 | $11K |
| 0012A | <1% | 153 | 142 | $7K | |
| 99393 | Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) | <1% | 78 | 65 | $6K |
| 0011A | <1% | 177 | 148 | $5K | |
| 90651 | <1% | 249 | 205 | $4K |
31 more codes
| 99384 | <1% | 50 | $3K | |
| 99383 | <1% | 46 | $3K | |
| 99203 | Doctor's office visit, new patient (routine) | <1% | 38 | $3K |
| 90686 | <1% | 2,504 | $3K | |
| 90734 | <1% | 396 | $2K | |
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, straightforward | <1% | 37 | $2K |
| 87880 | Infectious agent antigen detection by immunoassay; Streptococcus, group A | <1% | 156 | $2K |
| D0145 | Oral evaluation for a patient under three years of age | <1% | 56 | $1K |
| J1050 | Injection, medroxyprogesterone acetate, 1 mg | <1% | 30 | $1K |
| 96110 | Developmental screening, with scoring and documentation, per standardized instrument | <1% | 459 | $1K |
| D1206 | Topical application of fluoride varnish | <1% | 51 | $743.47 |
| 90715 | <1% | 232 | $479.28 | |
| 81025 | <1% | 108 | $329.64 | |
| 96160 | <1% | 810 | $300.96 | |
| 92551 | <1% | 757 | $255.15 | |
| 87491 | Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe | <1% | 66 | $208.36 |
| 87591 | Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe | <1% | 66 | $197.00 |
| 90633 | <1% | 74 | $128.56 | |
| 85018 | <1% | 22 | $60.20 | |
| 36415 | Collection of venous blood by venipuncture | <1% | 40 | $55.60 |
| 99173 | <1% | 1,112 | $50.35 | |
| 96127 | <1% | 406 | $4.49 | |
| 90688 | 0% | 202 | $0.00 | |
| 99000 | 0% | 569 | $0.00 | |
| 90656 | 0% | 33 | $0.00 | |
| 84443 | Thyroid stimulating hormone (TSH) | 0% | 35 | $0.00 |
| 91301 | 0% | 318 | $0.00 | |
| 87635 | Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe | 0% | 64 | $0.00 |
| 80053 | Comprehensive metabolic panel | 0% | 37 | $0.00 |
| 92552 | 0% | 188 | $0.00 | |
| 90710 | 0% | 15 | $0.00 |
Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.
From NPPES
Who's on the registration
Authorized officialGARDNER, FRANKLIN (HEALTH DIRCTOR)