KC MONTOYA
NPI 1194232652, individual, Athens, OH, Social Worker, Clinical
- Hours beyond a day in 6 months, but with up to 814 patients a month across 3 billing organizations, which points to a supervising clinician on the claims rather than one person's hours.
- Records needed.
Hours billed per day
Medicaid billing converted into hours of hands-on care per day. The lower bound counts one unit per claim line and needs no price; the other two divide dollars by a unit price, the conservative one at 1.5 times the price. The clinician on the claim may be a supervisor under state rules, so billing organizations are counted too.
| month | what was found | hours per day, lower bound | hours per day, at price | hours per day, conservative | per working day | patients | billing organizations | codes | paid |
|---|---|---|---|---|---|---|---|---|---|
| Apr 2024 | More hours than a day holds, even counting one unit per claim line | 38.4 | 39.5 | 26.4 | 26.5 | 719 | 1 | 90791 90832 90837 H0036 H2019 | $134K |
| May 2024 | More hours than a day holds, even counting one unit per claim line | 38.6 | 39.9 | 26.6 | 26.1 | 812 | 2 | 90791 90832 90834 90837 H0036 H2019 | $141K |
| Jun 2024 | More hours than a day holds, even counting one unit per claim line | 30.1 | 32.5 | 21.7 | 24.9 | 541 | 2 | 90791 90832 90837 H2019 | $110K |
| Jul 2024 | More hours than a day holds, even counting one unit per claim line | 31.3 | 35.3 | 23.5 | 22.1 | 708 | 3 | 90791 90832 90834 90837 H0036 H2019 | $126K |
| Aug 2024 | More hours than a day holds, even counting one unit per claim line | 34.9 | 40.5 | 27.0 | 24.3 | 814 | 3 | 90791 90832 90837 H0036 H2019 | $147K |
| Sep 2024 | More hours than a day holds, even counting one unit per claim line | 28.6 | 31.8 | 21.2 | 22.0 | 648 | 3 | 90791 90832 90834 90837 H0036 H2019 | $109K |
National provider registry
From the CMS NPPES Registry, refreshed daily.
| Name | KC MONTOYA |
| Type | Individual, sole proprietor |
| Status | Active |
| NPI issued | January 5, 2018, last updated October 13, 2025 |
| Practice location | 400 E STATE ST, Athens, OH 45701-1856, 740-326-6110 |
| Mailing address | 815 N GAY ST, Mount Vernon, OH 43050-1751 |
| Specialties | Social Worker, Clinical (1041C0700X, primary, license I.2102616-SUPV OH) |
Procedures billed
The specific codes behind the dollars. Medicaid figures come from T-MSIS (2018 to 2024) and are compared with every other provider billing the same code; Medicare figures come from the 2024 physician and supplier file and compare this provider's submitted charge with what Medicare allowed, against the usual ratio for that code.
| code | what it is | paid | share | per patient-month | typical | rank among providers | |
|---|---|---|---|---|---|---|---|
| 90837 | Psychotherapy, 1 hourhistory of abuse | $790K | 45% | $205 | $191 (top 5% from $442) | 56th percentile | |
| H2019 | Therapeutic behavioral services per 15 min | $394K | 22% | $160 | $226 (top 5% from $1K) | 29th percentile | |
| H0006 | Medicaid service code | $195K | 11% | $312 | $100 (top 5% from $371) | 93rd percentile | |
| H0015 | Alcohol/drug intensive outpatient per diemhistory of abuse | $171K | 10% | $2K | $666 (top 5% from $2K) | 91st percentile | |
| 90791 | Psychiatric diagnostic evaluation | $89K | 5% | $108 | $105 (top 5% from $228) | 54th percentile | |
| H0036 | Community psychiatric supportive treatment face-to-face per 15 minhistory of abuse | $74K | 4% | $86 | $195 (top 5% from $1K) | 27th percentile | |
| 90832 | Psychotherapy, 30 minutes | $46K | 3% | $73 | $59 (top 5% from $239) | 64th percentile | |
| 90834 | Psychotherapy, 45 minutes | $6K | 0% | $75 | $101 (top 5% from $318) | too few months to rank |
| code | what it is | services | beneficiaries | paid | submitted per service | allowed per service | charge to allowed | usual for this code |
|---|---|---|---|---|---|---|---|---|
| 90837 | Psychotherapy, 1 hour | 241 | 34 | $21K | $115 | $110 | 1.0x | 1.6x (90th percentile 2.9x) |
| 90791 | Psychiatric diagnostic evaluation | 30 | 27 | $3K | $124 | $122 | 1.0x | 1.9x (90th percentile 3.6x) |
A submitted charge many times the allowed amount is common and lawful; it matters when it is far above what other providers submit for the same code.
In this area
3 providers in Athens County, OH carry an indicator in the public record, with $3.0M at stake between them. The most common is more hours than a day holds, on 2 of them, followed by part of a provider network on 1.
| tier | provider | at stake | why |
|---|---|---|---|
| 3 | ARCADIA VALLEY SKILLED NURSING & REHABILITATION, INC. Coolville, OH, ranked 3138 | $0 |
|
| 4 | RANDALL COLUCCI Athens, OH, ranked 7733 | $1.6M |
|
| 5 | RONALD GORDINEER Athens, OH, ranked 10920 | $1.4M |
Recent enforcement in OH
All releasesDepartment of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.
Referral packet
The packet is a draft for a reviewer. It reads every public record behind this case, states what the records show with a citation for each finding, names the regulation each finding relates to, and lists the ordinary explanations to rule out first. It never asserts intent.