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 Massachusetts for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Massachusetts 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. Massachusetts (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.

Commonwealth Of Massachusetts (NPI 1073730347)

Field	Value
Entity Type	Organization
Organization	Commonwealth Of Massachusetts
Address	1 Ashburton Place 3rd Floor
City	Boston
State	MA
ZIP	02108
Taxonomy	Public Health or Welfare Agency
NPI Enumerated	April 19, 2007

Payer Source	Total Paid
Medicaid	$490.8M
Medicare	$0

Key Findings

This entity reports no Medicare billing on file and $490.8M in lifetime Medicaid revenue, making its commercial/Medicare footprint effectively nil and its financial scale concentrated entirely in Medicaid. For payer-mix analysis the provider should be treated as a Medicaid-first (effectively single-payer) organization rather than a mixed Medicare/Medicaid operator.

The provider's Medicaid revenue is highly concentrated: the precomputed top-3 Medicaid codes account for 100.0% of this provider's total Medicaid revenue, and a single code, H0018, represents 100.0% of its Medicaid revenue. That concentration means all reported Medicaid dollars — $490.8M — are driven by billing tied to H0018 rather than a diversified procedure mix.

H0018 (Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem) is the sole revenue driver by report, with 225.8K claims and an average paid per claim of $2174. This code mix indicates the Commonwealth is operating at scale in short-term residential behavioral health services and is billing on a per-diem basis for clinical/residential treatment components separate from room-and-board.

Competitive standing within Massachusetts is strong for this specific service line: the provider ranks #1 of 4 in-state for H0018 and sits at the 100th percentile among peers on that code. At the same time the available descriptor notes the provider’s volume for H0018 is "typical, unremarkable," which implies leadership in market share without an extreme statistical outlier status on per-provider utilization.

The operational and revenue risk profile is concentrated: because 100.0% of Medicaid revenue is tied to H0018 and there is no Medicare activity, the provider’s financial performance is exposed to changes in Medicaid policy, reimbursement rates, or state program eligibility for short-term residential behavioral health. Analysts should flag single-code, single-payer concentration as a material sensitivity when projecting revenue under alternative policy or rate scenarios.

The provider’s NPI was enumerated on 2007-04-19 (~19 years ago), indicating nearly two decades of documented billing activity under this enrollment. That tenure supports interpretations of established program operations and long-running participation in state Medicaid behavioral health financing.

The raw claims and payment metrics — 225.8K claims at an average paid per claim of $2174 — indicate high throughput and substantial per-claim reimbursement consistent with intensive short-term residential services. These operational metrics suggest a sizable capacity and recurring utilization pattern rather than infrequent, high-cost outlier events.

For benchmarking and peer comparisons, Medicare-based comparisons are not applicable due to absent Medicare billing; meaningful comparisons should be made against in-state Medicaid providers billing H0018 and other short-term residential behavioral health codes. Given the provider’s rank and volume profile on H0018, analysts should use state Medicaid short-term residential peers as the primary competitive set for rate, volume, and utilization benchmarking.

Medicaid: Complete Services Breakdown

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

1 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	225,780	$2,170	$490.8M

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Commonwealth Of Massachusetts — 1 of 1 code billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

1 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0018	Behavioral health; short-term residential (non-hospital residential treatment program), without room and board, per diem	1	10	60,540	$1,530	$132.9M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Everyfit, Inc.	MA	Emergency Response System Companies	$0	$15.2M
Jeffery Coen	MA	Podiatrist	$57K	$2K
Rosanna Lamalva	MA	Optometrist	$32.4K	$0

Commonwealth Of Massachusetts — Billing Profile & Reimbursement Data

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Commonwealth Of Massachusetts — 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