Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or South Dakota for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to South Dakota only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. South Dakota (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Advance (NPI 1053464867)

Field	Value
Entity Type	Organization
Organization	Advance
Address	301 Division Ave
City	Brookings
State	SD
ZIP	57006
Taxonomy	Case Management Agency
NPI Enumerated	January 18, 2007

Payer Source	Total Paid
Medicaid	$32.7M
Medicare	$0

Key Findings

This provider is effectively single‑payer and Medicaid‑focused: there is no Medicare billing on file and all lifetime revenue is from Medicaid ($32.7M). The absence of Medicare activity indicates the organization operates almost exclusively within Medicaid waiver and habilitation markets rather than billing Medicare fee‑for‑service programs.

Revenue is highly concentrated in a small set of waiver/habilitation codes: the top three Medicaid codes (T2016, T2020, T2025) together account for 90.2% of this provider’s total Medicaid revenue. In dollar terms those codes are driven by T2016 ($21.7M, 66.1%), T2020 ($5.5M, 16.8%), and T2025 ($2.4M, 7.2%), showing dependence on residential and day habilitation per‑diem services.

Business and service‑line implications: the code mix (predominantly T2016, T2020, and T2025) points to a core operation delivering waiver habilitation services — chiefly residential habilitation per diem and day habilitation — with substantial per‑diem reimbursement (T2016 avg paid/claim $3149; T2020 avg paid/claim $752). This suggests the provider’s scale and staffing are organized around long‑term residential and day‑program delivery models rather than short episodic clinical encounters.

Competitive standing for top codes is middling within the state: T2016 ranks #11 of 21 providers (50th percentile) and T2020 ranks #11 of 20 (47th percentile), both described as typical, unremarkable volume for these codes. Even though T2016 generates the majority of revenue, the provider is not a statewide dominant player for that code and appears to sit near the statewide median in market share for its highest‑revenue services.

Notable contrasts within its Medicaid portfolio: S0281 (medical home program / comprehensive care coordination) contributes $2.1M (6.5%) and ranks #10 of 21 (55th percentile), indicating the provider offers coordinated planning alongside habilitation but at a secondary revenue scale. Conversely, T1016 (case management, each 15 minutes) generates only $59.7K (0.2%) and ranks #38 of 38 (0th percentile), which is striking given the provider’s taxonomy as a Case Management Agency and may reflect limited billing for that specific case‑management CPT.

Smaller but interesting code signals: T2028 (specialized supply, waiver) appears frequently in claim count (5.9K claims) but represents only $254K (0.8%) of revenue while ranking #6 of 33 (84th percentile), suggesting the provider is relatively active in supplying waiver‑related materials compared with peers even though these items are low revenue per claim ($43 avg paid/claim). Similarly, several supported‑employment and transportation codes appear at very low revenue shares, confirming the organization’s primary focus is facility‑based habilitation rather than ancillary transport or employment services.

Tenure and operational continuity: the NPI was enumerated on 2007-01-18 (~19 years ago), indicating the provider has been active and present in the state Medicaid market for nearly two decades; that longevity aligns with the establishment of substantial residential/day habilitation revenue streams.

Risk or concentration observation for payers/contracting: with $32.7M entirely from Medicaid and 90.2% of that tied to three waiver/habilitation codes, the provider’s financial performance is sensitive to Medicaid policy or rate changes affecting T2016/T2020/T2025. Payers and contracting analysts should note this revenue concentration when evaluating rate negotiations, service authorization workflows, or programmatic changes to waiver per‑diem structures.

Medicaid: Complete Services Breakdown

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	6,880	$3,150	$21.7M
T2020	Day habilitation, waiver; per diem	7,310	$750	$5.5M
T2025	Waiver services; not otherwise specified (nos)	6,510	$360	$2.4M
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	6,400	$330	$2.1M
T2014	Habilitation, prevocational, waiver; per diem	1,270	$330	$423.2K
T2017	Habilitation, residential, waiver; 15 minutes	470	$670	$313.6K
T2028	Specialized supply, not otherwise specified, waiver	5,910	$40	$254K
T1016	Case management, each 15 minutes	740	$80	$59.7K
A9900	Miscellaneous dme supply, accessory, and/or service component of another hcpcs code	370	$80	$31.2K
T2018	Habilitation, supported employment, waiver; per diem	100	$100	$10.7K

Showing 1–10 of 13

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other South Dakota providers billing the same CPT/HCPCS codes.

Claims Volume vs. South Dakota Distribution

Advance — 0 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

13 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	11	20	6,880	$1,660	$31.6M
T2020	Day habilitation, waiver; per diem	11	20	7,340	$500	$8.9M
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	10	20	6,090	$420	$3M
T2025	Waiver services; not otherwise specified (nos)	7	20	5,410	$180	$1.9M
T1016	Case management, each 15 minutes	38	40	6,470	$50	$708.1K
T2017	Habilitation, residential, waiver; 15 minutes	6	10	470	$270	$437.9K
T2018	Habilitation, supported employment, waiver; per diem	17	20	1,510	$80	$433.9K
T2014	Habilitation, prevocational, waiver; per diem	8	20	1,210	$130	$410.3K
T2019	Habilitation, supported employment, waiver; per 15 minutes	12	20	480	$90	$288.6K
T2028	Specialized supply, not otherwise specified, waiver	6	30	910	$50	$169.8K

Showing 1–10 of 13

Nearby Providers

Other providers in the same ZIP code as Advance, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rural Health Care, Inc	SD	Federally Qualified Health Center (FQHC)	$0	$2.1M
East Central Mental Health & Chemical Dependency Center	SD	Community/Behavioral Health Agency	$0	$1.6M
City Of Brookings	SD	Multi-Specialty Clinic/Center	$0	$1.2M
Sanford Clinic	SD	Family Medicine Physician	$0	$606.7K
City Of Brookings	SD	Anesthesiology Physician	$0	$551.5K
City Of Brookings	SD	General Acute Care Hospital	$0	$548.5K
Brookings Family Dentistry, LLC	SD	Dental Clinic/Center	$0	$347.9K
Hy-vee Inc	SD	Community/Retail Pharmacy	$227.1K	$19.1K
Brookings Area Transit Authority Inc	SD	Bus	$0	$237.7K
Shelby Eischens	SD	Family Medicine Physician	$179.9K	$0

Advance — Billing Profile & Reimbursement Data

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Advance — Billing Profile & Reimbursement Data

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Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References