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

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

Twelvestone Medical, Inc. (NPI 1154418218)

Key Findings

Field	Value
Entity Type	Organization
Organization	Twelvestone Medical, Inc.
Address	352 W Northfield Blvd
City	Murfreesboro
State	TN
ZIP	37129
Taxonomy	Home Infusion Therapy Pharmacy
NPI Enumerated	October 9, 2006

Payer Source	Total Paid
Medicaid	$52.7M
Medicare	$0

TWELVESTONE MEDICAL, INC. reports $52.7M in lifetime Medicaid revenue and has no Medicare billing on file, making its active payment footprint effectively single-payer (Medicaid) based on available claims data. This concentration means analyses of its business and risk exposure should focus on Medicaid program reimbursement and utilization patterns rather than Medicare trends.

Revenue is highly concentrated in a very small set of codes: the precomputed top three Medicaid codes account for 71.2% of this provider's total Medicaid revenue. Those top drivers are J1726 at $20.6M (39.4%), B4161 at $9.1M (17.5%), and B4035 at $7.5M (14.3%), indicating a narrow set of services produce most cash flow.

The code mix indicates TWELVESTONE operates primarily as a home infusion and enteral nutrition pharmacy: dominant codes are enteral formulas and supply kits (B4161, B4035, B4160, B4149) along with per-diem home-therapy administration codes and infusion pumps (S9342, S9500, B9002). The presence of J1726 (hydroxyprogesterone caproate, Makena) and J1745 (infliximab) shows the organization also dispenses high-cost injectable therapies alongside routine enteral nutrition services.

TWELVESTONE is a dominant statewide provider for core enteral and home-nutrition services: multiple high-volume codes rank #1 in Tennessee and are at the 100th percentile versus in-state peers, including B4035 (rank #1 of 31, described as an "extreme outlier") and B4161 (rank #1 of 15, "notably above typical state volume"). These rank and percentile patterns position the provider as a major, leading supplier in the Tennessee Medicaid enteral/home-infusion market rather than a modest participant.

Several individual codes are flagged as statistical outliers or notably above typical volume, which reinforces the provider's outsized role in specific service lines. In particular, B4035 (106.9K claims) is labeled an "extreme outlier," and multiple enteral formula and supply codes (e.g., B4161 29.7K claims, B4160 41.7K claims, B4149 19.5K claims) are described as "notably above typical state volume," while J1745 (619 claims, $1.5M) ranks #2 of 4 (67th percentile) and is characterized as typical/unremarkable for that biologic.

Operational scale is evident from claim volumes across daily and per-diem services: the provider submitted 106.9K claims for B4035, 67.2K claims for S9342, 29.7K claims for B4161, and 41.7K claims for B4160, demonstrating large, recurring supply and service utilization consistent with long-term home enteral nutrition and pump-dependent therapy management. The mix of pump, kit, formula, and per-diem care coordination codes indicates an integrated supply-and-service model rather than sporadic episodic dispensing.

TWELVESTONE's NPI was enumerated on 2006-10-09 (~20 years ago), signaling long tenure in the marketplace. That longevity, paired with the provider's rank dominance on multiple enteral codes, suggests an established operational presence and likely entrenched contracts or referral pathways within Tennessee Medicaid.

The heavy reliance on a few high-revenue lines — with the top three codes accounting for 71.2% of Medicaid revenue — creates concentrated reimbursement exposure: changes in coverage, unit pricing, or utilization policy for J1726 or enteral nutrition/supply codes could materially affect overall revenue. Given the provider's statewide dominance on many of these codes, payers and analysts should prioritize monitoring these specific codes for policy shifts, audit focus, or competitive entry that could alter the provider's financial profile.

Medicaid: Complete Services Breakdown

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

61 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
J1726	Injection, hydroxyprogesterone caproate, (makena), 10 mg	27,740	$740	$20.6M
B4161	Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding…	29,690	$310	$9.1M
B4035	Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	106,900	$70	$7.5M
B4160	Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals,…	41,750	$90	$3.9M
B4149	Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral…	19,460	$160	$3.1M
J1745	Injection, infliximab, excludes biosimilar, 10 mg	620	$2,430	$1.5M
B4034	Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	43,360	$20	$1M
B4152	Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include…	19,300	$40	$791.2K
B4153	Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral…	5,780	$130	$739.7K
S9342	Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits…	67,230	$10	$739.6K

Showing 1–10 of 61

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Twelvestone Medical, Inc. — 14 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

61 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
J1726	Injection, hydroxyprogesterone caproate, (makena), 10 mg	1	10	1,310	$830	$4.8M
B4161	Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding…	1	20	2,380	$330	$2.3M
B4035	Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	1	30	3,000	$90	$961.2K
J1745	Injection, infliximab, excludes biosimilar, 10 mg	2	10	460	$2,200	$896.4K
S9342	Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits…	1	10	14,670	$30	$808.8K
B4160	Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals,…	1	20	2,850	$110	$728.4K
J0585	Injection, onabotulinumtoxina, 1 unit	10	20	200	$880	$709.1K
B4149	Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral…	1	10	1,170	$160	$514.8K
B4185	Parenteral nutrition solution, not otherwise specified, 10 grams lipids	2	10	3,420	$130	$435.7K
B4153	Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral…	1	10	1,140	$170	$344.4K

Showing 1–10 of 61

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Volunteer Behavioral Health Care System	TN	Counselor	$0	$168M
Crossroads Urgent Care PLLC	TN	Family Medicine Physician	$0	$21.6M
Murfreesboro Medical Clinic, P.A.	TN	Specialist	$0	$19.7M
Jones Therapy Services LLC	TN	Pediatric Rehabilitation Medicine Physician	$0	$19.3M
Saint Thomas Rutherford Hospital	TN	General Acute Care Hospital	$0	$16.2M
Charis Hearts Inc.	TN	Home Health Agency	$0	$8.2M
Gateway Healthcare, PC	TN	Urgent Care Clinic/Center	$0	$3.9M
Duratech Medical, Inc.	TN	Prosthetic/Orthotic Supplier	$0	$3.3M
Trustpoint Hospital LLC	TN	Psychiatry Physician	$0	$3.2M
Hometown Respiratory Consultants LLC	TN	Oxygen Equipment & Supplies (DME)	$0	$3.1M

Twelvestone Medical, Inc. — Billing Profile & Reimbursement Data

Sign up for Twelvestone Medical, Inc. — Billing Profile & Reimbursement Data policy alerts

Twelvestone Medical, Inc. — Billing Profile & Reimbursement Data

Sign up for Twelvestone Medical, Inc. — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References