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.

New Mexico Department Of Health (NPI 1194886499)

Field	Value
Entity Type	Organization
Organization	New Mexico Department Of Health
Address	7905 Marble Ave Ne
City	Albuquerque
State	NM
ZIP	87110
Taxonomy	Customized Equipment (DME)
NPI Enumerated	December 12, 2006

Payer Source	Total Paid
Medicaid	$60.4M
Medicare	$0

Key Findings

This provider effectively operates as a Medicaid-only billing entity: there is no Medicare billing on file and total Medicaid revenue is $60.4M, so payer mix is almost entirely Medicaid-based rather than split between Medicare and Medicaid. That concentration makes Medicaid policy and waiver reimbursement particularly material to the provider's financial performance.

Revenue is highly concentrated in a very small set of waiver habilitation codes: the precomputed top three codes (T2016, H2021, T2021) account for 92.5% of the provider's total Medicaid revenue. Those three codes are T2016 ($47.3M, 78.4% of total Medicaid revenue), H2021 ($5.3M, 8.9%), and T2021 ($3.2M, 5.3%), indicating a narrow revenue base centered on a few service lines.

The code mix points to a business focused on residential and community habilitation services: T2016 is habilitation, residential, waiver (per diem), H2021 is community-based wrap-around services (per 15 minutes), and T2021 is day habilitation, waiver (per 15 minutes). Together these codes suggest the provider operates residential care and community/day habilitation programs under Medicaid waivers rather than primarily delivering durable medical equipment, which is notable given the listed taxonomy of Customized Equipment (DME).

T2016 is the dominant single revenue driver and shows very large utilization: 116.3K claims and $47.3M in revenue, and the data notes this volume as "typical, unremarkable volume for this code" despite ranking #4 of 40 providers in-state at the 92th percentile. In other words, Medicaid payers in New Mexico commonly reimburse significant per-diem habilitation residential services, and this provider is a high-volume but not anomalous participant for that code.

H2021 and T2021 together represent meaningful secondary lines of business with state-level visibility: H2021 has 32.2K claims and $5.3M revenue (ranks #8 of 62, 89th percentile, described as "typical, unremarkable volume for this code"), and T2021 has 32K claims and $3.2M revenue (ranks #7 of 52, 88th percentile, "typical, unremarkable volume for this code"). These percentiles place the provider in the upper range of in-state peers for community-based wrap-around and day habilitation services, indicating a solid but not dominant market position in these segments.

Other Medicaid codes are much smaller contributors: T2033 accounts for $3M (4.9% of Medicaid revenue) with 4K claims and ranks #27 of 39 (32th percentile, "typical, unremarkable volume for this code"), and T2025 contributes $1.6M (2.6% of revenue) with 1.6K claims and ranks #15 of 35 (59th percentile, "typical, unremarkable volume for this code"). These figures indicate modest participation in additional residential/NOS waiver services but not a major diversification away from the top three codes.

The provider has an established operational tenure: the NPI was enumerated on 2006-12-12 (~20 years ago), which supports that the organization is a long-standing participant in the state Medicaid market rather than a recent entrant. That longevity, combined with heavy Medicaid exposure, suggests institutional experience delivering waiver habilitation services in New Mexico.

The single-payer profile and extreme revenue concentration create both operational leverage and downside exposure: because top codes T2016, H2021, and T2021 together account for 92.5% of Medicaid revenue and there is no Medicare revenue, changes to Medicaid waiver rules, per-diem rates, or utilization patterns for those specific service lines could materially affect the provider's revenue. Analysts should treat reimbursement or policy shifts affecting residential habilitation and community/day habilitation as the primary drivers of future financial variability for this entity.

Medicaid: Complete Services Breakdown

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

5 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	116,330	$410	$47.3M
H2021	Community-based wrap-around services, per 15 minutes	32,210	$170	$5.3M
T2021	Day habilitation, waiver; per 15 minutes	32,040	$100	$3.2M
T2033	Residential care, not otherwise specified (nos), waiver; per diem	3,990	$750	$3M
T2025	Waiver services; not otherwise specified (nos)	1,580	$980	$1.6M

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

New Mexico Department Of Health — 0 of 5 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

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	4	40	54,080	$360	$22.1M
T2033	Residential care, not otherwise specified (nos), waiver; per diem	27	40	11,070	$280	$10.8M
H2021	Community-based wrap-around services, per 15 minutes	8	60	6,750	$340	$4.4M
T2021	Day habilitation, waiver; per 15 minutes	7	50	6,810	$120	$1.6M
T2025	Waiver services; not otherwise specified (nos)	15	40	1,010	$360	$1.6M

Nearby Providers

Other providers in the same ZIP code as New Mexico Department Of Health, 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
Community Options, Inc	NM	Child Intellectual and/or Developmental Disabilities Respite Care	$0	$76.7M
Abarim Home Health Care Inc.	NM	Community Based Hospice Care Agency	$0	$66M
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

New Mexico Department Of Health — Billing Profile & Reimbursement Data

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New Mexico Department Of Health — 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