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

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

Northern Kentucky Consumer Directed Options Program (NPI 1104958370)

Field	Value
Entity Type	Organization
Organization	Northern Kentucky Consumer Directed Options Program
Address	22 Spiral Dr
City	Florence
State	KY
ZIP	41042
Taxonomy	Supports Brokerage Agency
NPI Enumerated	March 12, 2007

Payer Source	Total Paid
Medicaid	$52.8M
Medicare	$0

Key Findings

This provider is effectively a Medicaid-focused operation with $52.8M in lifetime Medicaid revenue and no Medicare billing on file. The absence of any Medicare claims means payer exposure is concentrated entirely in Medicaid programs rather than split across federal and state payers.

Revenue for this entity is extremely concentrated: the top three Medicaid codes S5108, T2040, and T1005 together account for 98.8% of this provider's total Medicaid revenue. That concentration indicates the organization’s financial performance is driven almost exclusively by a very small set of waiver/home-care services.

The mix of high-volume codes aligns with the provider’s taxonomy as a Supports Brokerage Agency: S5108 (home care training to home care client), T2040 (financial management, self-directed, waiver), and T1005 (respite care services) dominate billing. This pattern suggests the organization primarily delivers home-care training, fiscal/financial management for self-directed waiver participants, and respite supports rather than broad clinical or acute services.

S5108 is the single largest revenue driver at $42.2M (79.8% of this provider's total Medicaid revenue) from 376.4K claims with an average paid/claim of $112, and the provider ranks #7 of 101 in-state (94th percentile) — described here as notably above typical state volume. That ranking positions the provider as a major state-level supplier of home-care training services and indicates market leadership for this specific code.

T2040 contributes $8.7M (16.4% of this provider's total Medicaid revenue) from 25.2K claims at $345 avg paid/claim and ranks #13 of 43 in-state (71th percentile), which is characterized as typical, unremarkable volume for that code. T1005 contributes $1.4M (2.6% of this provider's total Medicaid revenue) from 27.3K claims at $50 avg paid/claim and ranks #11 of 81 in-state (88th percentile); despite the relatively high percentile for T1005, the commentary labels it typical volume, indicating these are secondary, routine revenue streams.

Several smaller codes account for only fractionally small shares of revenue: T1016 ($344.2K, 0.7% share; 3.8K claims; ranks #29 of 63, 55th percentile) and T1999 ($267.9K, 0.5% share; 2.4K claims; ranks #11 of 36, 71th percentile) are modest contributors consistent with case management and supplies. The record also shows 97535 with 356 claims but $0 avg paid/claim and $0 revenue (0.0% of Medicaid revenue), ranked #188 of 305 (38th percentile), indicating occasional reporting of other CPTs without material revenue impact.

The provider has a long tenure in the NPI registry (enumerated 2007-03-12, ~19 years ago), signaling an established presence in the state Medicaid market and likely sustained operational relationships with waiver programs. Combined with the dominant share driven by S5108 and the role as a Supports Brokerage Agency, this longevity supports the interpretation of an operationally mature, specialized provider.

Because 98.8% of Medicaid revenue is concentrated in three codes, the provider’s financial performance is highly sensitive to policy, rate, or authorization changes affecting S5108 and T2040 in particular. For analysts evaluating competitive or contractual risk, any shifts in state waiver rules or reimbursement for these high-volume codes would be expected to have outsized effects on this provider’s revenue profile.

Medicaid: Complete Services Breakdown

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

6 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S5108	Home care training to home care client, per 15 minutes	376,410	$110	$42.2M
T2040	Financial management, self-directed, waiver; per 15 minutes	25,180	$350	$8.7M
T1005	Respite care services, up to 15 minutes	27,250	$50	$1.4M
T1016	Case management, each 15 minutes	3,780	$90	$344.2K
T1999	Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks"	2,370	$110	$267.9K
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	360	$0	$0

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

Northern Kentucky Consumer Directed Options Program — 0 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

6 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5108	Home care training to home care client, per 15 minutes	7	100	43,820	$140	$16.6M
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	188	310	830	$120	$3.7M
T2040	Financial management, self-directed, waiver; per 15 minutes	13	40	14,910	$160	$3.5M
T1016	Case management, each 15 minutes	29	60	3,410	$120	$970.5K
T1005	Respite care services, up to 15 minutes	11	80	2,880	$70	$799.2K
T1999	Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks"	11	40	1,370	$160	$315.4K

Nearby Providers

Other providers in the same ZIP code as Northern Kentucky Consumer Directed Options Program, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Personal Touch Home Care Of Ky, Inc.	KY	Home Health Agency	$0	$127.2M
St Elizabeth Medical Center, Inc	KY	General Acute Care Hospital	$0	$65.5M
Healthy Adult Day Healthcare, LLC	KY	Adult Day Care Clinic/Center	$0	$37.7M
Dungarvin Kentucky, LLC - Florence	KY	Developmentally Disabled Services Day Training Agency	$0	$35.3M
Northern Kentucky Consumer Directed Option Program	KY	Supports Brokerage Agency	$0	$27.5M
Personal Touch Home Care Of Ky, Inc.	KY	Home Health Agency	$0	$13.2M
Tri-generations, LLC	KY	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$11.2M
Bawac, Inc.	KY	Developmentally Disabled Services Day Training Agency	$0	$5.5M
Advanced Technology Of Kentucky Inc.	KY	Oxygen Equipment & Supplies (DME)	$0	$5.1M
Northern Kentucky Center For Pain Relief, LLC	KY	Pain Medicine (Anesthesiology) Physician	$0	$4.8M

Northern Kentucky Consumer Directed Options Program — Billing Profile & Reimbursement Data

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Northern Kentucky Consumer Directed Options Program — 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