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.

Community Options, Inc. (NPI 1194028969)

Field	Value
Entity Type	Organization
Organization	Community Options, Inc.
Address	16 Farber Rd
City	Princeton
State	NJ
ZIP	08540
Taxonomy	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
NPI Enumerated	December 16, 2010

Payer Source	Total Paid
Medicaid	$337.7M
Medicare	$0

Key Findings

Taxonomy and service focus: COMMUNITY OPTIONS, INC. is classified as an Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility, and the Medicaid code mix—dominated by H2016 (Comprehensive community support services, per diem) and supplemented by H0004 (behavioral health counseling and therapy)—is consistent with an organization delivering intensive community support and embedded behavioral health services to individuals with intellectual/developmental disabilities. The predominance of per-diem community support billing suggests ongoing residential or community-based program operations rather than episodic medical care.

Payer mix: This entity has no Medicare billing on file and reports $337.7M in lifetime Medicaid revenue, making it effectively a single-payer (Medicaid-focused) billing entity in the available data. Analysts should treat Medicaid as the sole source of reported government fee-for-service revenue for benchmarking and risk assessments.

Revenue concentration: The top three Medicaid codes account for 100.0% of this provider's total Medicaid revenue, indicating extremely high revenue concentration in a very small set of service lines. That concentration means financial performance and utilization patterns will be heavily driven by changes in coverage, rates, or utilization for those specific codes.

H2016 operational scale and standing: H2016 accounts for $335.3M of Medicaid revenue with 815.9K claims and an average paid per claim of $411, representing 99.3% of the provider's Medicaid revenue. The provider ranks #2 of 206 in-state for H2016 (100th percentile) and is labeled an "extreme outlier," signaling it is a dominant, far-above-typical-volume provider of comprehensive community support services within the state.

H0004 service delivery: H0004 generated $2.2M in revenue from 23.8K claims at an average paid per claim of $93 and represents 0.7% of Medicaid revenue. The provider ranks #2 of 64 in-state for H0004 (98th percentile) and is described as an "extreme outlier," indicating unusually high delivery of behavioral health counseling and therapy relative to peers and likely integration of therapy into its community-support programs.

A0090 transportation activity: A0090 (non-emergency transportation per mile, vehicle provided by an individual with vested interest) produced $110.2K in revenue from 6.9K claims at $16 average paid per claim, representing 0.0% of Medicaid revenue. The provider ranks #119 of 227 in-state (48th percentile) for A0090, a typical, unremarkable level of non-emergency transportation billing compared with peers.

Competitive implications: Given the #2 statewide rankings and extreme outlier status on both H2016 and H0004, the provider is a major in-state player for community support and behavioral health counseling services tied to intellectual/developmental disability care. For payers and network managers, this profile flags a high-volume specialist that could be a focal point for rate negotiations, care-management partnerships, or targeted utilization reviews within the state.

Tenure and stability: The provider's NPI was enumerated on 2010-12-16 (~16 years ago), indicating a long-standing presence in the Medicaid market. This longevity, combined with concentrated high-volume billing for core service lines, suggests an established operational footprint that has been sustained over multiple years.

Medicaid: Complete Services Breakdown

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

3 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2016	Comprehensive community support services, per diem	815,910	$410	$335.3M
H0004	Behavioral health counseling and therapy, per 15 minutes	23,770	$90	$2.2M
A0090	Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest	6,890	$20	$110.2K

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

Community Options, Inc. — 2 of 3 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

3 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2016	Comprehensive community support services, per diem	2	210	23,310	$490	$41.9M
H0004	Behavioral health counseling and therapy, per 15 minutes	2	60	1,570	$70	$253.4K
A0090	Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest	119	230	7,800	$10	$218.8K

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
Eden Autism Services.	NJ	Developmentally Disabled Services Day Training Agency	$0	$167M
Enable, Inc.	NJ	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$79.3M
Community Options Enterprises, Inc	NJ	Developmentally Disabled Services Day Training Agency	$0	$63.5M
Neighbours, Inc	NJ	Case Management Agency	$0	$55.3M
Princeton Healthcare System, A New Jersey Non-profit Corporation	NJ	Psychiatric Hospital Unit	$0	$34M
Beacon Specialized Living New Jersey, Inc.	NJ	Developmentally Disabled Services Day Training Agency	$0	$32.5M
Princeton Child Development Institute	NJ	Community/Behavioral Health Agency	$0	$15.2M
Lingraphicare America, Inc	NJ	Durable Medical Equipment & Medical Supplies	$0	$13.1M
Values Into Action Nj, Inc.	NJ	Case Management Agency	$0	$11.5M
Association For Advancement Of Mental Health	NJ	Community/Behavioral Health Agency	$0	$10.2M

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