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

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

Commonwealth Of Massachusetts (NPI 1245364595)

Field	Value
Entity Type	Organization
Organization	Commonwealth Of Massachusetts
Address	60 Main Street
City	Brockton
State	MA
ZIP	02301
Taxonomy	Case Management Agency
NPI Enumerated	March 16, 2007

Payer Source	Total Paid
Medicaid	$309.8M
Medicare	$0

Key Findings

This entity is effectively a Medicaid-centric provider: Medicare billing is listed as none on file while lifetime Medicaid revenue is $309.8M. The absence of Medicare activity means analyses of competitive positioning and service mix should focus on Medicaid-funded programs and waivers rather than fee-for-service Medicare lines.

Revenue is extremely concentrated in a small set of Medicaid codes: the top 3 codes account for 94.4% of the provider's total Medicaid revenue, and a single code, T2016, represents the dominant share with $254.8M revenue (82.2% of this provider's total Medicaid revenue). This level of concentration indicates the organization’s finances are heavily dependent on a single service type and payment modality.

The provider’s code mix and dollar volumes point to operations focused on intensive habilitation and supportive programs: T2016 (Habilitation, residential, waiver; per diem) dominates revenue, S5100 (Day care services, adult; per 15 minutes) is the next largest driver, and T2023 (Targeted case management; per month) appears as a material recurring case management line. The presence of substantial T2023 activity aligns with the listed taxonomy of Case Management Agency, showing both service delivery and ongoing care coordination roles.

Competitive standing for the core residential habilitation line (T2016) is modest within-state: the provider ranks #14 of 25 in-state and sits at the 46th percentile with a descriptor of "typical, unremarkable volume for this code." Despite the very large dollar amount reported for T2016, its in-state rank suggests similar residential habilitation providers also capture substantial shares of this market segment.

By contrast, the provider is a clear statewide outlier for adult day care services: S5100 generated $26.5M (8.5% of Medicaid revenue) from 84.6K claims and the provider ranks #8 of 189 in-state at the 96th percentile, described as "notably above typical state volume for this code." This indicates a strong operational footprint and competitive edge in day care services relative to most peers.

Other Medicaid lines show operational breadth but much smaller revenue shares: T2003 (Non-emergency transportation; encounter/trip) accounted for 174.3K claims and $4.5M revenue (1.5% of total) and ranks #20 of 245 in-state at the 92th percentile, suggesting high trip volume but low per-claim payments. Smaller but recurring program codes such as T2019, T2021, H2015, and H2023 each contribute around 1.0%–1.5% of revenue and mostly rank in middle percentiles, indicating typical participation across these ancillary service lines rather than dominance.

Operational tenure is long-standing: the NPI was enumerated on 2007-03-16 (~19 years ago), so the provider has an established Medicaid billing history over many years. When combined with $309.8M of Medicaid revenue and the extreme concentration in waiver-based habilitation and adult day services, this suggests a mature organization whose strategic risk is concentrated in sustaining reimbursement and capacity for a small set of core Medicaid programs.

Medicaid: Complete Services Breakdown

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

9 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	29,660	$8,590	$254.8M
S5100	Day care services, adult; per 15 minutes	84,550	$310	$26.5M
T2023	Targeted case management; per month	32,910	$340	$11.2M
T2003	Non-emergency transportation; encounter/trip	174,310	$30	$4.5M
T2019	Habilitation, supported employment, waiver; per 15 minutes	32,250	$110	$3.4M
T2021	Day habilitation, waiver; per 15 minutes	14,830	$230	$3.4M
H2015	Comprehensive community support services, per 15 minutes	7,620	$400	$3.1M
H2023	Supported employment, per 15 minutes	24,980	$120	$2.9M
S5125	Attendant care services; per 15 minutes	60	$510	$30.3K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Commonwealth Of Massachusetts — 1 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	14	30	29,930	$10,070	$358.9M
T2023	Targeted case management; per month	16	70	8,210	$510	$8.6M
H2023	Supported employment, per 15 minutes	14	20	28,450	$190	$5.6M
H2015	Comprehensive community support services, per 15 minutes	75	150	7,770	$140	$4.8M
S5125	Attendant care services; per 15 minutes	38	40	3,390	$300	$4.7M
T2021	Day habilitation, waiver; per 15 minutes	17	20	20,590	$210	$4.5M
S5100	Day care services, adult; per 15 minutes	8	190	2,000	$230	$3.1M
T2019	Habilitation, supported employment, waiver; per 15 minutes	9	20	24,690	$120	$3.1M
T2003	Non-emergency transportation; encounter/trip	20	250	40,490	$30	$2.2M

Nearby Providers

Other providers in the same ZIP code as Commonwealth Of Massachusetts, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Old Colony Elderly Services, Inc.	MA	Case Management Agency	$0	$137.5M
South Bay Mental Health Center, Inc.	MA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$112M
Massachusetts Mentor LLC	MA	Foster Care Agency	$0	$95.6M
Brockton Neighborhood Health Center	MA	Federally Qualified Health Center (FQHC)	$0	$91.2M
Sb Transitional Sub, LLC	MA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$84.8M
Steward Good Samaritan Medical Center, Inc.	MA	General Acute Care Hospital	$0	$64.2M
Pediatric Services Of America, LLC	MA	Nursing Care Agency	$0	$47.8M
South Bay Mental Health Center, Inc.	MA	Adolescent and Children Mental Health Clinic/Center	$0	$43.2M
Sb Transitional Sub, LLC	MA	Early Intervention Provider Agency	$0	$35.9M
Healthier You Wellness Nutrition Partners Of Greater Boston, LLC	MA	Health Maintenance Organization	$0	$33.8M

Commonwealth Of Massachusetts — 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