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

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

Utopia Home Care Inc (NPI 1164460820)

Field	Value
Entity Type	Organization
Organization	Utopia Home Care Inc
Address	444 Foxon Rd
City	East Haven
State	CT
ZIP	06513
Taxonomy	Home Health Agency
NPI Enumerated	June 3, 2006

Payer Source	Total Paid
Medicaid	$81.4M
Medicare	$0

Key Findings

This provider is effectively a single-payer Medicaid operator: there is no Medicare billing on file and lifetime Medicaid revenue is $81.4M. The absence of Medicare activity means the business is concentrated on state Medicaid programs for its payer exposure and revenue growth opportunities.

Revenue is highly concentrated in a small set of service codes: the top 3 Medicaid codes account for 78.3% of this provider's total Medicaid revenue. The largest contributors are T1004 ($25.8M, 31.7%), T1502 ($24.5M, 30.1%), and S9123 ($13.4M, 16.4%), indicating most income derives from a narrow portfolio of high-volume home-care services.

The code mix (T1004, T1502, S9123 and related codes) signals an operational model built around high-frequency in-home direct care: personal care and nursing aide visits (T1004), medication administration visits (T1502), and hourly RN nursing care (S9123). This pattern is consistent with an agency focused on delivering hands-on, visit-based community care rather than episode-based skilled home health bundles.

Competitive standing in Connecticut is dominant for several key services. T1004 is a pronounced outlier (807.8K claims, ranks #2 of 63 providers in-state, 98th percentile; extreme outlier) and S9123 is similarly elevated (278.4K claims, ranks #2 of 79 providers in-state, 99th percentile; extreme outlier), while T1502 (742.9K claims, ranks #3 of 37 providers, 94th percentile) is high-volume but characterized as typical for that code, together indicating the provider is a major statewide provider for in-home aide and nursing services.

Operational scale implied by claim volumes points to a large frontline workforce and significant visit logistics: T1004 shows 807.8K claims, T1502 shows 742.9K claims, and S9123 shows 278.4K claims. Delivering hundreds of thousands of short-duration visits at the reported average paid rates will require robust scheduling, payroll, and compliance processes to support aides and nurses in the field.

Payment mix reflects a low-unit-price, high-frequency delivery model: average paid per claim is $32 for T1004, $33 for T1502, and $48 for S9123, which combined with the very large claim counts drives overall revenue. This suggests the organization relies on volume of brief visits and hourly nursing shifts rather than fewer, higher-dollar procedures to generate $81.4M in Medicaid revenue.

The provider shows unique or sole-state billing footprints on several ancillary codes, notably T1019 (77.1K claims, $10.1M revenue, ranks #1 of 1 providers in-state) and multiple S51xx codes where it is the only in-state biller. These single-provider rankings indicate specialized contracts or niche service lines within the state Medicaid program that may differentiate the agency from peers.

UTOPIA HOME CARE INC has longstanding market tenure, with its NPI enumerated on 2006-06-03 (~20 years ago). The combination of multi-decade presence and concentrated high-volume Medicaid billing suggests an established operator with deep integration into Connecticut’s Medicaid home-care delivery system.

Medicaid: Complete Services Breakdown

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

14 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1004	Services of a qualified nursing aide, up to 15 minutes	807,780	$30	$25.8M
T1502	Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional, per visit	742,860	$30	$24.5M
S9123	Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used)	278,440	$50	$13.4M
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	77,080	$130	$10.1M
S9124	Nursing care, in the home; by licensed practical nurse, per hour	65,320	$50	$3.1M
G0162	Skilled services by a registered nurse (rn) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an rn to ensure that…	69,570	$40	$2.6M
S5130	Homemaker service, nos; per 15 minutes	14,980	$60	$839K
T1503	Administration of medication, other than oral and/or injectable, by a health care agency/professional, per visit	14,100	$40	$521.7K
T1001	Nursing assessment / evaluation	10,070	$30	$251.8K
S5125	Attendant care services; per 15 minutes	2,470	$60	$150.8K

Showing 1–10 of 14

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Connecticut Distribution

Utopia Home Care Inc — 5 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

14 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1502	Administration of oral, intramuscular and/or subcutaneous medication by health care agency/professional, per visit	3	40	98,180	$50	$17.4M
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	1	10	77,080	$130	$10.1M
S9124	Nursing care, in the home; by licensed practical nurse, per hour	7	70	5,660	$150	$3.6M
T1004	Services of a qualified nursing aide, up to 15 minutes	2	60	26,810	$40	$2.8M
S9123	Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used)	2	80	14,190	$80	$2.7M
S5130	Homemaker service, nos; per 15 minutes	1	10	14,980	$60	$833.1K
G0162	Skilled services by a registered nurse (rn) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an rn to ensure that…	3	60	4,250	$50	$511.6K
S5125	Attendant care services; per 15 minutes	1	10	2,470	$60	$149.7K
99509	A home health provider, such as a registered nurse, or a non nursing practitioner, visits a patient to provide help with activities of daily living, or ADLs, and self care.	1	10	4,340	$30	$147.3K
T1001	Nursing assessment / evaluation	3	60	1,000	$60	$140.5K

Showing 1–10 of 14

Nearby Providers

Other providers in the same ZIP code as Utopia Home Care Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
American Medical Response Of Connecticut Incorporated	CT	Ambulance	$13.2M	$129.5M
Fair Haven Community Health Clinic Inc	CT	Federally Qualified Health Center (FQHC)	$0	$83.7M
Docs Medical Inc	CT	Family Medicine Physician	$0	$33.5M
Utopia Assisted Living Services	CT	Assisted Living Facility	$0	$5.3M
Fair Haven Community Health Clinic, Inc	CT	Federally Qualified Health Center (FQHC)	$0	$3.1M
New Haven Family Dental Group LLC	CT	Dentist	$0	$2M
Dr. Dental Of East Haven, PC	CT	General Practice Dentistry	$0	$1.8M
Catholic Charities, Inc. - Archdiocese Of Hartford	CT	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$1.6M
The Mary Wade Home, Incorporated	CT	Skilled Nursing Facility	$0	$1.5M
Holistic Health & Healing Center LLC	CT	Clinical Social Worker	$0	$1.4M

Utopia Home Care Inc — Billing Profile & Reimbursement Data

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Utopia Home Care Inc — 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