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

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

Fourth Avenue Homes Inc. (NPI 1205012507)

Field	Value
Entity Type	Organization
Organization	Fourth Avenue Homes Inc.
Address	140 4th Ave
City	Spicer
State	MN
ZIP	56288
Taxonomy	Mental Illness Community Based Residential Treatment Facility
NPI Enumerated	January 16, 2008

Payer Source	Total Paid
Medicaid	$63.6M
Medicare	$0

Key Findings

FOURTH AVENUE HOMES INC. appears to operate primarily as a residential care provider: its top revenue codes are S5140 (Foster care, adult; per diem) and T2016 (Habilitation, residential, waiver; per diem), which implies the facility is delivering per-diem, room-and-board–style services and residential habilitation rather than outpatient or episodic clinical visits. The presence of H0045 (Respite care services, not in the home, per diem) and S5150 (Unskilled respite care, not hospice; per 15 minutes) further supports a roster of long-stay and supportive residential services focused on daily supervision and respite rather than procedure-based care.

Revenue is highly concentrated in a very small number of Medicaid codes: S5140 generates $49M (77.0% of this provider's total Medicaid revenue), T2016 generates $14.2M (22.3%), and H0045 generates $397.8K (0.6%), and the precomputed top-three share is 99.9% of total Medicaid revenue. This concentration indicates that the business’s financial performance is tightly linked to reimbursement and utilization patterns for adult foster care and residential habilitation per-diem services.

This provider is effectively single-payer from a claims perspective: there is no Medicare billing on file while lifetime Medicaid revenue is $63.6M. Analysts should treat Medicaid reimbursement policy and state-level waiver rules as the primary drivers of revenue risk and operational priorities for FOURTH AVENUE HOMES INC., since Medicare does not appear in its reported billing mix.

Competitive standing in-state is modest rather than dominant for the provider’s highest-revenue codes: S5140 ranks #23 of 59 providers in-state at the 62th percentile (characterized in the source as typical, unremarkable volume), while T2016 ranks #22 of 34 at the 36th percentile (also labeled typical, unremarkable). These ranks suggest the provider is a routine participant for these lines of service within Minnesota, not a clear market leader.

For the smaller Medicaid codes, the provider’s positioning is mixed: H0045 (Respite care services) brings $397.8K and ranks #3 of 5 providers in-state at the 50th percentile (described as typical), indicating limited competition or a thin market for that service; S5150 is a very small revenue contributor ($41K, 0.1% of Medicaid revenue) and ranks #15 of 19 at the 22th percentile, marking it as a marginal offering in the provider’s portfolio.

Claim-level economics reinforce the residential-service profile: S5140 shows 112.1K claims with an average paid/claim of $437, while T2016 shows 29.6K claims with an average paid/claim of $478. These per-claim payments are consistent with per-diem residential reimbursement and imply the provider’s revenue scale is driven by volume of bed-days and enrollment in waiver-based habilitation programs.

The provider’s tenure is long enough to be operationally established: the NPI was enumerated on 2008-01-16 (~18 years ago). That longevity, combined with concentrated Medicaid revenue, suggests an established relationship with state Medicaid programs and likely operational experience in managing residential placements and waiver billing.

Given that the top three Medicaid codes account for 99.9% of revenue, business and regulatory changes affecting S5140 or T2016 reimbursement, eligibility, or utilization would have outsized impact on the provider’s finances. Analysts should prioritize monitoring state foster-care per-diem rates, waiver policy updates for residential habilitation, and utilization trends in adult foster-care placements when assessing financial or operational risk 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.

4 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S5140	Foster care, adult; per diem	112,060	$440	$49M
T2016	Habilitation, residential, waiver; per diem	29,630	$480	$14.2M
H0045	Respite care services, not in the home, per diem	1,620	$250	$397.8K
S5150	Unskilled respite care, not hospice; per 15 minutes	500	$80	$41K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Minnesota Distribution

Fourth Avenue Homes Inc. — 0 of 4 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Minnesota

Full comparison — all codes billed, vs. Minnesota median

4 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5140	Foster care, adult; per diem	23	60	33,770	$300	$37.6M
T2016	Habilitation, residential, waiver; per diem	22	30	84,870	$240	$23.9M
S5150	Unskilled respite care, not hospice; per 15 minutes	15	20	2,680	$150	$3.4M
H0045	Respite care services, not in the home, per diem	3	10	1,620	$270	$609.5K

Fourth Avenue Homes Inc. — Billing Profile & Reimbursement Data

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Fourth Avenue Homes 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

Frequently Asked Questions

References