MOONLIGHT MOUNTAIN RECOVERY, INC
NPI: 1861983413
· POCATELLO, ID 83201
· 261QM0801X
$17.64M
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
35,398 |
$11.81M |
| 2024 |
20,588 |
$5.83M |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H0035 |
Mh partial hosp tx under 24h |
39,927 |
3,689 |
$16.01M |
| H0015 |
Alcohol and/or drug services |
10,091 |
1,407 |
$1.32M |
| T1017 |
Targeted case management |
2,338 |
1,533 |
$112K |
| 90791 |
|
704 |
704 |
$90K |
| 99212 |
|
786 |
660 |
$29K |
| 90853 |
|
1,083 |
346 |
$28K |
| H0038 |
Self-help/peer svc per 15min |
595 |
367 |
$26K |
| 99213 |
|
267 |
215 |
$14K |
| 99204 |
|
71 |
71 |
$9K |
| 99215 |
Prolong outpt/office vis |
32 |
31 |
$4K |
| 90832 |
|
60 |
40 |
$3K |
| 99214 |
|
32 |
32 |
$3K |