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

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

Community Options, Inc (NPI 1184838104)

Field	Value
Entity Type	Organization
Organization	Community Options, Inc
Address	2720 San Pedro Dr Ne
City	Albuquerque
State	NM
ZIP	87110
Taxonomy	Child Intellectual and/or Developmental Disabilities Respite Care
NPI Enumerated	May 9, 2007

Payer Source	Total Paid
Medicaid	$76.7M
Medicare	$0

Key Findings

COMMUNITY OPTIONS, INC reports $76.7M in lifetime Medicaid revenue and has no Medicare billing on file, making it effectively a single-payer (Medicaid) provider in scale and reimbursement exposure. This payer concentration implies that analyses of financial risk and service capacity should focus on Medicaid policy and waiver program changes rather than Medicare dynamics.

Revenue is highly concentrated: the top three Medicaid codes account for 94.3% of the provider’s total Medicaid revenue, driven by T2016 ($53.9M, 70.3%), H2021 ($12.8M, 16.7%), and T2033 ($5.6M, 7.4%). This concentration indicates that a small set of service lines under waiver and residential habilitation rules produce nearly all billed Medicaid dollars.

The reported code mix aligns with the provider taxonomy (Child Intellectual and/or Developmental Disabilities Respite Care) and operationally indicates a dual focus on residential habilitation and community wrap-around supports. Dominance of T2016 (habilitative residential, waiver; per diem) and significant H2021 (community-based wrap-around, per 15 minutes) revenue suggests the organization runs sustained residential programs alongside time-based community services for individuals with developmental disabilities.

For key service lines the provider is a major statewide competitor: T2016 ranks #3 of 40 providers in-state (95th percentile) and H2021 ranks #3 of 62 providers in-state (97th percentile), both described as notably above typical state volume. These rank/percentile positions imply market leadership in New Mexico for residential habilitation per diems and wrap-around community supports.

Other billed services show more typical participation: T2033 (residential care, nos, waiver) generated $5.6M and ranks #14 of 39 (66th percentile), and T2021 (day habilitation, waiver) generated $3.5M and ranks #11 of 52 (80th percentile). These placements indicate the organization is an established but not dominant provider for those supplementary waiver services.

Smaller codes and outlier notes reinforce the operational focus: T2025 ($729.8K, 1.0% of Medicaid revenue) ranks #20 of 35 (44th percentile) and H2022 ($144.4K, 0.2% of Medicaid revenue) ranks #2 of 2 (0th percentile) and are described as typical or unremarkable; this suggests limited activity in NOS waiver categories and rare utilization of certain per-diem wrap-around billing streams.

The dominant revenue drivers are a mix of per-diem (T2016, T2033) and time-based (H2021, T2021) codes, implying the provider’s service model combines long-stay residential capacity with billed, minute-level community interventions. From a payer/contracting perspective this mix signals exposure to both residential occupancy management and finely tracked, time-based authorization and documentation requirements.

The NPI has been enumerated on 2007-05-09 (~19 years ago), indicating a long-tenured presence in the state Medicaid market; combined with its concentrated Medicaid revenue and high in-state ranks for core codes, the provider appears to be an established, specialized participant focused on IDD residential and wrap-around waiver services.

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
T2016	Habilitation, residential, waiver; per diem	148,410	$360	$53.9M
H2021	Community-based wrap-around services, per 15 minutes	44,700	$290	$12.8M
T2033	Residential care, not otherwise specified (nos), waiver; per diem	23,210	$240	$5.6M
T2021	Day habilitation, waiver; per 15 minutes	19,690	$180	$3.5M
T2025	Waiver services; not otherwise specified (nos)	840	$870	$729.8K
H2022	Community-based wrap-around services, per diem	2,530	$60	$144.4K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

Community Options, Inc — 1 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

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

6 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	3	40	54,080	$360	$22.1M
T2033	Residential care, not otherwise specified (nos), waiver; per diem	14	40	11,070	$280	$10.8M
H2021	Community-based wrap-around services, per 15 minutes	3	60	6,750	$340	$4.4M
H2022	Community-based wrap-around services, per diem	2	10	3,170	$780	$2.5M
T2021	Day habilitation, waiver; per 15 minutes	11	50	6,810	$120	$1.6M
T2025	Waiver services; not otherwise specified (nos)	20	40	1,010	$360	$1.6M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
1st Care Of New Mexico LLC	NM	In Home Supportive Care Agency	$0	$86.5M
Abarim Home Health Care Inc.	NM	Community Based Hospice Care Agency	$0	$66M
New Mexico Department Of Health	NM	Customized Equipment (DME)	$0	$60.4M
Independent Living Resource Center	NM	Personal Care Attendant	$0	$57.7M
Ability First, LLC	NM	Exclusive Provider Organization	$0	$49M
Alta Mira Specialized Family Services, Inc.	NM	Community/Behavioral Health Agency	$0	$46.2M
Southwest Family Guidance Center LLC	NM	Adolescent and Children Mental Health Clinic/Center	$0	$32.7M
Aid Home Health Care Services LLC.	NM	Home Health Agency	$0	$32.4M
Active Solutions Incorporated	NM	Developmentally Disabled Services Day Training Agency	$0	$31.3M
Great Livin', LLC	NM	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$27.1M

Community Options, Inc — Billing Profile & Reimbursement Data

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Community Options, 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