Clinic
Spectrum Health Systems, INC
Spectrum Health Systems, INC was paid $187.39M by Medicaid between Jan 2018 and Dec 2024, across 23 billing codes. Its largest line is H0020, Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) — 49% of everything it billed.
33Billing provider infoSPECTRUM HEALTH SYSTEMS, INC
WORCESTER, MA 01605
WORCESTER, MA 01605
33aNPI1487608485assigned 05/22/2006
33bProvider typeSubstance Use Disorder Rehabilitation Clinic/Center
28Total paid$187.39M
24GClaims7,479,414
24DCodes billed23
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Substance Use Disorder Rehabilitation Clinic/Center providers in Massachusetts
Rank by total paid#1 of 15
Median peer was paid$1.26M
This provider vs. median149×
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 | 1,428,099 | $22.68M | |
| 2019 | 1,460,084 | $23.74M | |
| 2020 | 1,408,741 | $23.12M | |
| 2021 | 1,362,967 | $22.74M | |
| 2022 | 1,405,650 | $26.74M | |
| 2023 | 246,787 | $38.97M | |
| 2024incomplete | 167,086 | $29.41M |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| H0020 | Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) | 49% | 6,764,011 | 290,490 | $92.10M |
| G2067 | Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatment program) | 31% | 414,280 | 122,182 | $57.92M |
| H0019 | Behavioral health; long-term residential (non-medical, non-acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem | 8.4% | 113,335 | 5,143 | $15.74M |
| H0010 | Alcohol and/or drug services; sub-acute detoxification (residential addiction program inpatient) | 3.9% | 22,079 | 2,351 | $7.37M |
| H0011 | Alcohol and/or drug services; acute detoxification (residential addiction program inpatient) | 3.4% | 14,678 | 3,277 | $6.36M |
| H0004 | Behavioral health counseling and therapy, per 15 minutes | 1.2% | 41,155 | 27,403 | $2.25M |
| H0005 | Alcohol and/or drug services; group counseling by a clinician | <1% | 47,217 | 20,731 | $1.40M |
| 90791 | Psychiatric diagnostic evaluationPsychiatric diagnostic evaluation | <1% | 7,968 | 7,833 | $974K |
| G2074 | Medication assisted treatment, weekly bundle not including the drug, including substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program) | <1% | 8,868 | 6,146 | $930K |
| G2078 | Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure | <1% | 19,513 | 11,381 | $627K |
| 99213 | Doctor's office visit, returning patient (routine)Office or other outpatient visit for the evaluation and management of an established patient, low complexity | <1% | 8,957 | 7,975 | $593K |
| 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 | <1% | 4,363 | 4,012 | $439K |
11 more codes
| 90837 | Psychotherapy session, about an hour | <1% | 2,682 | $221K |
| G2076 | Intake activities, including initial medical examination that is conducted by an appropriately licensed practitioner and preparation of a care plan, which may be informed by administration of a standardized, evidence-based assessment, and that includes the patient's goals and mutually agreed-upon actions for the patient to meet those goals, including harm reduction interventions; the patient's needs and goals in the areas of education, vocational training, and employment; and the medical and psychiatric, psychosocial, economic, legal, housing, physical activity and/or nutrition needs and other recovery support services that a patient needs and wishes to pursue, conducted by an appropriately licensed/credentialed personnel (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code | <1% | 1,308 | $188K |
| H2015 | Community support for mental illness or disability, per 15 minutes | <1% | 5,345 | $165K |
| 90832 | Psychotherapy session, about 30 minutes | <1% | 1,028 | $39K |
| 90853 | Group psychotherapy (other than of a multiple-family group) | <1% | 1,164 | $28K |
| 90834 | Psychotherapy session, about 45 minutes | <1% | 194 | $15K |
| 90882 | <1% | 544 | $12K | |
| G2077 | Periodic assessment; assessing periodically by an otp practitioner and includes a review of moud dosing, treatment response, other substance use disorder treatment needs, responses and patient-identified goals, and other relevant physical, nutrition and psychiatric treatment needs and goals; may be informed by administration of a standardized, evidence-based assessment, or the need and interest for harm reduction interventions and recovery support services (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to each primary code | <1% | 225 | $3K |
| H0015 | Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therapies or education | <1% | 34 | $3K |
| 99203 | Doctor's office visit, new patient (routine) | <1% | 24 | $2K |
| G2080 | Each additional 30 minutes of counseling in a week of medication assisted treatment, (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure | <1% | 442 | $1K |
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 officialELLIS, SHERRY (CHIEF OPERATING OFFICER)
| Provider | Location | Paid |
|---|---|---|
| Stanley Street Treatment and Resources, INC. | Fall River, MA | $38.40M |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.