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

Why is the Medicaid comparison limited to Rhode Island 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. Rhode Island (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.

Looking Upwards, Inc. (NPI 1164543765)

Field	Value
Entity Type	Organization
Organization	Looking Upwards, Inc.
Address	1184 E Main Rd
City	Portsmouth
State	RI
ZIP	02871
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	April 2, 2007

Payer Source	Total Paid
Medicaid	$136.2M
Medicare	$0

Key Findings

LOOKING UPWARDS, INC. is effectively a single-payer Medicaid provider: there is no Medicare billing on file and the provider reports $136.2M in lifetime Medicaid revenue, indicating the organization’s scale is concentrated entirely in Medicaid-funded services. This payer mix suggests exposure to Medicaid policy and waiver changes rather than Medicare reimbursement dynamics.

Revenue is highly concentrated: the precomputed top three Medicaid codes account for 89.5% of the provider’s Medicaid revenue, driven by T2033 ($83.3M; 61.2%), T2021 ($27M; 19.8%), and T2017 ($11.7M; 8.6%). Those three codes dominate the financial profile and imply that a small set of service lines generate the bulk of cash flow.

The code mix and code descriptions point to a core business model focused on waiver-funded residential and day habilitation services: T2033 is residential care, T2021 is day habilitation per 15 minutes, and T2017 is residential habilitation per 15 minutes. The presence of both per-diem (T2033) and per-15-minute habilitation codes (T2021, T2017) indicates operations that combine staffed residential programs with time-based day habilitation services.

State-level competitive standing for the largest revenue drivers is strong: LOOKING UPWARDS ranks #3 of 22 for T2033 (90th percentile), #3 of 33 for T2021 (94th percentile), and #2 of 36 for T2017 (97th percentile). These ranks place the provider among the top in-state operators for residential and habilitation waiver services, consistent with their large absolute Medicaid revenue in those lines.

Non-residential support services also form meaningful components of operational footprint: T2003 (non-emergency transportation) shows 37.6K claims and $6.5M revenue, and T2022 (case management) contributes $2.5M from 15.4K claims. The high claim volume for transportation suggests the provider operates substantial logistics or transport capacity to move participants between residences, day programs, and community activities.

There are notable statistical outliers in volume relative to peers for some smaller service lines: the provider ranks #1 of 16 for T2015 (prevocational, per hour) at the 100th percentile and is labeled "notably above typical state volume" despite T2015 representing only $283.5K (0.2%) of Medicaid revenue. This indicates an unusually high state-level concentration in prevocational services compared with peers, even though it is not a major revenue driver.

LOOKING UPWARDS bills a handful of unique or low-volume codes that may reflect specialized offerings: H2025 (ongoing support to maintain employment) is billed ($6.1K) and is the only state provider listed for that code, with no peer volume comparison available, while T5999 supply billing and small psychotherapy entries appear at very low totals. These items suggest the provider offers some niche employment-support or supply services in addition to its core residential and day habilitation programs.

The provider’s NPI was enumerated on 2007-04-02 (~19 years ago), indicating long tenure in the state market; combined with top-state ranks on major waiver codes, this longevity supports the characterization of LOOKING UPWARDS as an established, sizable in-state provider of waiver-funded residential and habilitation services.

Medicaid: Complete Services Breakdown

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

15 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2033	Residential care, not otherwise specified (nos), waiver; per diem	30,780	$2,710	$83.3M
T2021	Day habilitation, waiver; per 15 minutes	75,810	$360	$27M
T2017	Habilitation, residential, waiver; 15 minutes	30,700	$380	$11.7M
T2003	Non-emergency transportation; encounter/trip	37,550	$170	$6.5M
T2022	Case management, per month	15,440	$160	$2.5M
T2016	Habilitation, residential, waiver; per diem	2,050	$1,190	$2.4M
T2019	Habilitation, supported employment, waiver; per 15 minutes	6,190	$320	$2M
T2023	Targeted case management; per month	1,020	$280	$288.1K
T2015	Habilitation, prevocational, waiver; per hour	3,380	$80	$283.5K
T2025	Waiver services; not otherwise specified (nos)	1,260	$120	$155.1K

Showing 1–10 of 15

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Rhode Island Distribution

Looking Upwards, Inc. — 2 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Rhode Island

Full comparison — all codes billed, vs. Rhode Island median

15 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2033	Residential care, not otherwise specified (nos), waiver; per diem	3	20	6,780	$1,890	$39.8M
T2017	Habilitation, residential, waiver; 15 minutes	2	40	3,820	$510	$10.6M
T2021	Day habilitation, waiver; per 15 minutes	3	30	12,340	$410	$10M
T2016	Habilitation, residential, waiver; per diem	3	10	2,050	$1,830	$5M
T2025	Waiver services; not otherwise specified (nos)	9	30	620	$70	$1.2M
T2022	Case management, per month	4	40	5,460	$150	$1.2M
T2003	Non-emergency transportation; encounter/trip	4	60	7,480	$80	$1.1M
T2020	Day habilitation, waiver; per diem	11	20	450	$950	$864.4K
T2019	Habilitation, supported employment, waiver; per 15 minutes	3	10	1,870	$230	$688.6K
T2015	Habilitation, prevocational, waiver; per hour	1	20	330	$460	$396.2K

Showing 1–10 of 15

Nearby Providers

Other providers in the same ZIP code as Looking Upwards, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Looking Upwards, Inc.	RI	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$15.7M
Looking Upwards, Inc.	RI	Multi-Specialty Clinic/Center	$0	$7.4M
Girls And Boys Town Of New England	RI	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$5.9M
Newport County Regional Special Education	RI	Local Education Agency (LEA)	$0	$1.5M
Tom Swanson	RI	Pediatric Dentistry	$0	$1.3M
Gina Digati	RI	Adult Psychiatric/Mental Health Clinical Nurse Specialist	$12.3K	$817.1K
Lighthouse Counseling Associates	RI	Clinical Social Worker	$0	$343.5K
Town Of Portsmouth	RI	Land Ambulance	$265.6K	$75.3K
East Bay Endoscopy Center LLC	RI	Endoscopy Clinic/Center	$330.2K	$0
Julie Deleo	RI	Internal Medicine Physician	$156.9K	$4.4K

Looking Upwards, Inc. — Billing Profile & Reimbursement Data

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Looking Upwards, 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