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

Why is the Medicaid comparison limited to New Jersey 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. New Jersey (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.

The Arc Of Monmouth (NPI 1114307428)

Field	Value
Entity Type	Organization
Organization	The Arc Of Monmouth
Address	1158 Wayside Rd
City	Tinton Falls
State	NJ
ZIP	07712
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	June 2, 2015

Payer Source	Total Paid
Medicaid	$84.6M
Medicare	$0

Key Findings

THE ARC OF MONMOUTH is effectively a single-payer Medicaid provider: it has no Medicare billing on file and reports $84.6M in lifetime Medicaid revenue. The absence of Medicare activity combined with large Medicaid receipts indicates operations are focused almost entirely on Medicaid-funded developmental-disability services rather than fee-for-service Medicare care.

Revenue is highly concentrated in a very small set of service codes: the precomputed top three Medicaid codes account for 97.3% of the provider's total Medicaid revenue. The three revenue drivers are H2016 (179.5K claims, $324 avg paid/claim, $58.1M revenue; 68.7% of total), T2021 (148.2K claims, $155 avg paid/claim, $23M revenue; 27.2% of total), and T2015 (15.6K claims, $78 avg paid/claim, $1.2M revenue; 1.4% of total), so policy or rate changes to these codes would materially affect overall revenue.

The code mix and volumes indicate a day-habilitation and community-support business model: H2016 (Comprehensive community support services, per diem) and T2021 (Day habilitation, waiver; per 15 minutes) together represent the bulk of billed services and revenue, reflecting continuous, programmatic support and high-frequency contact with clients rather than episodic medical procedures. T2015 (Habilitation, prevocational, waiver; per hour) adds a smaller but relevant prevocational offering, consistent with a provider operating structured day programs and workforce-preparation services for people with developmental disabilities.

Competitive standing by code is mixed within New Jersey: H2016 generates the largest revenue share but ranks #26 of 206 providers in-state (88th percentile; labeled "typical, unremarkable volume"), suggesting high absolute dollars without a dominant statewide market position for that code. By contrast, T2021 ranks #19 of 218 providers (92th percentile; labeled "notably above typical state volume"), indicating a comparatively strong position in day habilitation services, and T2015 ranks #9 of 70 (88th percentile), showing above-average placement in prevocational habilitation.

Several ancillary service lines appear at materially lower revenue levels but demonstrate breadth of community-based supports: H2015 (15.3K claims, $51 avg, $781.4K revenue; 0.9% of total) ranks #8 of 113 (94th percentile), H2021 (5K claims, $95 avg, $477.1K revenue; 0.6% of total) ranks #72 of 194 (63th percentile), and A0090 (24.2K claims, $9 avg, $218.2K revenue; 0.3% of total) ranks #63 of 227 (73th percentile). These line items point to wraparound supports, time-based community services, and substantial non-emergency transport usage in program delivery.

Operational scale and throughput are high: claims volumes for the two dominant codes are large (H2016 179.5K claims and T2021 148.2K claims), which implies sustained daily service delivery, staffing needs, and program infrastructure to support continuous community and day habilitation programs. High claim counts combined with per-claim payment levels ($324 and $155 respectively) explain the concentrated revenue profile and operational intensity.

Service mix includes clinical and therapy services alongside habilitation: codes such as 97535 (2.9K claims, $69 avg, $198.1K revenue; 0.2% of total; rank #26 of 218, 88th percentile), S8990 (2.4K claims, $76 avg, $185.1K revenue; 0.2% of total; rank #12 of 22, 48th percentile), H0004 (4.1K claims, $41 avg, $168.3K revenue; 0.2% of total; rank #24 of 64, 63th percentile), and 92507 (2.3K claims, $67 avg, $155.1K revenue; 0.2% of total; rank #73 of 194, 63th percentile) indicate provision of maintenance therapy, behavioral health counseling, and speech/communication services as part of a broader habilitation offering.

The provider has an established presence: its NPI was enumerated on 2015-06-02 (~11 years ago), supporting that reported volumes and revenue reflect several years of program operations rather than a recent market entry. Given the concentration in a few waiver- and community-support codes, monitoring reimbursement policy changes for H2016, T2021, and T2015 will be important for payers or partners assessing financial and operational stability.

Medicaid: Complete Services Breakdown

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

11 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2016	Comprehensive community support services, per diem	179,450	$320	$58.1M
T2021	Day habilitation, waiver; per 15 minutes	148,230	$160	$23M
T2015	Habilitation, prevocational, waiver; per hour	15,610	$80	$1.2M
H2015	Comprehensive community support services, per 15 minutes	15,320	$50	$781.4K
H2021	Community-based wrap-around services, per 15 minutes	5,020	$100	$477.1K
A0090	Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest	24,240	$10	$218.2K
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	2,870	$70	$198.1K
S8990	Physical or manipulative therapy performed for maintenance rather than restoration	2,440	$80	$185.1K
H0004	Behavioral health counseling and therapy, per 15 minutes	4,110	$40	$168.3K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	2,320	$70	$155.1K

Showing 1–10 of 11

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Jersey Distribution

The Arc Of Monmouth — 0 of 11 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Jersey

Full comparison — all codes billed, vs. New Jersey median

11 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2016	Comprehensive community support services, per diem	26	210	23,310	$490	$41.9M
T2021	Day habilitation, waiver; per 15 minutes	19	220	14,500	$170	$7.7M
H2021	Community-based wrap-around services, per 15 minutes	72	190	3,010	$260	$3.1M
H2015	Comprehensive community support services, per 15 minutes	8	110	1,860	$140	$1.1M
T2019	Habilitation, supported employment, waiver; per 15 minutes	40	60	1,540	$110	$696.7K
T2015	Habilitation, prevocational, waiver; per hour	9	70	2,810	$100	$671.2K
S8990	Physical or manipulative therapy performed for maintenance rather than restoration	12	20	2,470	$120	$639K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	73	190	860	$100	$534.8K
H0004	Behavioral health counseling and therapy, per 15 minutes	24	60	1,570	$70	$253.4K
A0090	Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest	63	230	7,800	$10	$218.8K

Showing 1–10 of 11

Related Providers

Other providers that share a Tax Identification Number (TIN) with The Arc Of Monmouth, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sahar Shafey	NJ	Psychiatry Physician	$37.8K	$0

Nearby Providers

Other providers in the same ZIP code as The Arc Of Monmouth, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ladacin Network	NJ	Developmentally Disabled Services Day Training Agency	$0	$95.3M
Assistive Choices Incorporated	NJ	Home Health Agency	$0	$22.9M
First Healthcare Asbury Park LLC	NJ	Adult Day Care Clinic/Center	$0	$19.3M
Gold Chris Associates, LLC	NJ	Clinic/Center	$0	$13.6M
Rj Healthcare Services LLC	NJ	Home Health Agency	$0	$12M
Elbaum, Krost & Elbaum, Dds, PA	NJ	Oral and Maxillofacial Surgery (Dentist)	$0	$10M
Central Jersey Urgent Care	NJ	Urgent Care Clinic/Center	$0	$8.4M
Jeffrey Elbaum	NJ	Oral and Maxillofacial Surgery (Dentist)	$8.1K	$3.7M
Ian Hersh	NJ	Foot & Ankle Surgery Podiatrist	$1M	$0
Rany Al Haj	NJ	Rheumatology Physician	$779.1K	$0

The Arc Of Monmouth — Billing Profile & Reimbursement Data

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The Arc Of Monmouth — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References