Agency
Potomac Highlands Guild
Potomac Highlands Guild was paid $38.85M by Medicaid between Jan 2018 and Dec 2024, across 10 billing codes. Its largest line is S5125, attendant care at home, billed per 15 minutes — 71% of everything it billed.
33Billing provider infoPOTOMAC HIGHLANDS GUILD
PETERSBURG, WV 26847
PETERSBURG, WV 26847
33aNPI1720273170assigned 09/10/2007
33bProvider typeCommunity/Behavioral Health Agency
28Total paid$38.85M
24GClaims213,260
24DCodes billed10
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Community/Behavioral Health Agency providers in West Virginia
Rank by total paid#8 of 93
Median peer was paid$1.97M
This provider vs. median20×
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 | 30,995 | $5.41M | |
| 2019 | 34,147 | $5.47M | |
| 2020 | 27,894 | $5.83M | |
| 2021 | 28,053 | $6.38M | |
| 2022 | 29,911 | $6.92M | |
| 2023 | 32,125 | $4.96M | |
| 2024incomplete | 30,135 | $3.88M |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| S5125 | Attendant care at home, billed per 15 minutesAttendant care services; per 15 minutes | 71% | 86,057 | 9,606 | $27.50M |
| T1005 | Respite care services, up to 15 minutes | 12% | 4,236 | 4,098 | $4.84M |
| T2021 | Day program for adults with developmental disabilities, per 15 minutesDay habilitation, waiver; per 15 minutes | 5.3% | 38,632 | 6,662 | $2.06M |
| A0160 | Non-emergency transportation: per mile - case worker or social worker | 3.5% | 14,105 | 6,032 | $1.37M |
| G9002 | Coordinated care fee, maintenance rate | 3.2% | 6,212 | 6,062 | $1.25M |
| T1016 | Case management, each 15 minutes | 2.2% | 25,473 | 5,854 | $856K |
| A0120 | Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems | 1.0% | 22,918 | 1,869 | $407K |
| T1002 | Rn services, up to 15 minutes | <1% | 9,101 | 1,613 | $292K |
| T1003 | Lpn/lvn services, up to 15 minutes | <1% | 4,775 | 1,032 | $184K |
| T2024 | Service assessment/plan of care development, waiver | <1% | 1,751 | 1,548 | $99K |
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 officialRAINES, FREDERICK (PSYCHIATRIST)
| Provider | Location | Paid |
|---|---|---|
| Potomac Highlands Guild | Petersburg, WV | $465K |
Matched on the authorized-official name exactly as entered in NPPES. A common name can match unrelated people.