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

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

Hale Nui Community Services, Inc. (NPI 1205108461)

Field	Value
Entity Type	Organization
Organization	Hale Nui Community Services, Inc.
Address	67-292 Goodale Ave
City	Waialua
State	HI
ZIP	96791
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	February 3, 2012

Payer Source	Total Paid
Medicaid	$5.6M
Medicare	$0

Key Findings

This provider reports no Medicare billing on file and $5.6M in lifetime Medicaid revenue, meaning its operations are effectively single-payer and dependent on Medicaid reimbursement streams. The NPI was enumerated 2012-02-03 (~14 years ago), indicating an established provider presence in the market rather than a recent entrant.

Revenue is highly concentrated: the precomputed top 3 Medicaid codes account for 99.4% of this provider's total Medicaid revenue. Those codes are T2016 (516 claims, $4300 avg paid/claim, $2.2M revenue; 39.4% of Medicaid revenue), H2021 (2.7K claims, $688 avg paid/claim, $1.8M revenue; 32.7% of Medicaid revenue), and S5140 (341 claims, $4490 avg paid/claim, $1.5M revenue; 27.2% of Medicaid revenue).

The mix of codes and the listed taxonomy (Developmentally Disabled Services Day Training Agency) point to a service model focused on residential habilitation and community-based support for developmentally disabled adults. High per-diem averages for T2016 ($4300) and S5140 ($4490) combined with substantial H2021 volume (2.7K claims at $688 avg) suggest a business that pairs a smaller number of relatively expensive residential placements with a larger volume of shorter-interval wrap-around community services.

Competitive standing by code is modest within the state: T2016 ranks #9 of 9 providers (0th percentile) and is described as typical/unremarkable in volume despite representing the single largest revenue line for this provider; H2021 ranks #15 of 24 providers (39th percentile), positioning the provider below median for community-based wrap-around services; S5140 ranks #4 of 7 providers (50th percentile), placing it near the mid-range for foster-care adult per-diem billing. Together, these ranks indicate the provider is not a dominant statewide player for these lines.

Payment and utilization profile is mixed: the provider generates most revenue from relatively high-paid per-diem codes (T2016 and S5140) but relies on large unit counts for H2021 to reach material revenue. The contrast between 516 T2016 claims and 2.7K H2021 claims, along with the differing average paid/claim amounts, signals a dual reliance on both intensive residential placements and frequent community-based service encounters.

Smaller billed codes contribute negligible revenue and activity: H2032 accounts for $22.6K (0.4% of Medicaid revenue) with 48 claims and ranks #14 of 14 providers (0th percentile), while H2015 accounts for $13.2K (0.2% of Medicaid revenue) with 183 claims and ranks #26 of 31 providers (17th percentile). These low shares indicate limited exposure to activity therapy and comprehensive community support services relative to the provider's dominant codes.

Given the absence of Medicare revenue and the concentration in a few Medicaid service lines, the provider carries payer and service-line concentration risk; any changes in Medicaid policy or rates for T2016, H2021, or S5140 would likely have an outsized impact on overall revenue. The data suggest monitoring state-level reimbursement trends for these three codes to assess financial vulnerability.

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	520	$4,300	$2.2M
H2021	Community-based wrap-around services, per 15 minutes	2,670	$690	$1.8M
S5140	Foster care, adult; per diem	340	$4,490	$1.5M
H2032	Activity therapy, per 15 minutes	50	$470	$22.6K
H2015	Comprehensive community support services, per 15 minutes	180	$70	$13.2K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Hawaii Distribution

Hale Nui Community Services, Inc. — 0 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Hawaii

Full comparison — all codes billed, vs. Hawaii median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	9	10	2,740	$1,170	$8.6M
H2021	Community-based wrap-around services, per 15 minutes	15	20	4,710	$400	$3.5M
S5140	Foster care, adult; per diem	4	10	340	$4,170	$3.2M
H2032	Activity therapy, per 15 minutes	14	10	1,660	$110	$1.6M
H2015	Comprehensive community support services, per 15 minutes	26	30	2,300	$30	$634.2K

Hale Nui Community Services, Inc. — Billing Profile & Reimbursement Data

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Hale Nui Community Services, 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