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

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

District 4 Cdo Program (NPI 1255468617)

Field	Value
Entity Type	Organization
Organization	District 4 Cdo Program
Address	177 Graham Ave
City	Bowling Green
State	KY
ZIP	42101
Taxonomy	Supports Brokerage Agency
NPI Enumerated	February 27, 2007

Payer Source	Total Paid
Medicaid	$54.7M
Medicare	$0

Key Findings

This provider is effectively single‑payer: there is no Medicare billing on file while total Medicaid revenue is $54.7M, indicating the organization operates primarily within the Medicaid program rather than across Medicare/Medicaid. For analysts comparing payer scale, Medicaid is the sole material source of recorded revenue.

The provider has an established presence: its NPI was enumerated on 2007-02-27 (~19 years ago), which suggests nearly two decades of operational history in the state Medicaid market. That tenure supports experience with waiver and home-care program billing patterns.

Revenue is highly concentrated: the precomputed top-3 codes account for 98.1% of this provider's total Medicaid revenue, with S5108 alone contributing $45.2M (82.5%). This level of concentration means changes in reimbursement or utilization for those few codes would materially affect overall revenue.

The code mix signals a programmatic focus on home- and waiver-support services consistent with its taxonomy as a Supports Brokerage Agency. S5108 (Home care training to home care client, per 15 minutes) and T2040 (Financial management, self-directed, waiver; per 15 minutes) comprise the bulk of revenue, while T1016 (Case management, each 15 minutes) appears as a smaller but related care coordination line, indicating operations centered on training, fiscal management, and case support for waiver participants.

Competitive standing is mixed by service line: S5108 is a major outlier in state scale—399.6K claims, $45.2M revenue and ranks #5 of 101 providers in-state (96th percentile), described as notably above typical state volume—whereas T2040 (27.2K claims, $7.7M, rank #11 of 43, 76th percentile) and T1016 (7.4K claims, $835.7K, rank #16 of 63, 76th percentile) are more typical, mid‑ranking participants. Additionally, T1999 (7K claims, $593.7K) ranks #1 of 36 providers (100th percentile), showing localized dominance for that miscellaneous supplies code despite its modest share of total revenue.

Operational scale and billing intensity are significant for the leading service: 399.6K claims for S5108 with an average paid/claim of $113 implies very high throughput for home-care training activities, while T2040’s higher average paid/claim of $282 with 27.2K claims indicates fewer but higher‑paid fiscal‑management service units. These differences in claim count and unit price shape the provider’s revenue profile and suggest distinct workflows for training versus financial management services.

There are identifiable statistical outliers to monitor: S5108 is flagged as notably above typical state volume and T1999 is at the 100th percentile for its code, indicating the provider is a statewide leader for that miscellaneous therapeutic/supplies code. Even though T1999 represents only $593.7K (1.1% of revenue), its top rank suggests a specific operational or procurement capability that differentiates this provider from peers.

From a risk/strategy perspective, the combination of single‑payer reliance on Medicaid and extreme revenue concentration in a single code (S5108 at 82.5%) creates sensitivity to policy, rate, or utilization shifts for home‑care training and waiver financial-management rules. Analysts should prioritize monitoring state policy changes, audit focus on high‑volume home‑care training claims, and any shifts in utilization of S5108 or T2040 that would materially alter the provider’s financial picture.

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
S5108	Home care training to home care client, per 15 minutes	399,620	$110	$45.2M
T2040	Financial management, self-directed, waiver; per 15 minutes	27,180	$280	$7.7M
T1016	Case management, each 15 minutes	7,400	$110	$835.7K
T1999	Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks"	6,990	$90	$593.7K
T1005	Respite care services, up to 15 minutes	10,620	$40	$456.8K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Kentucky Distribution

District 4 Cdo Program — 2 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Kentucky

Full comparison — all codes billed, vs. Kentucky median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5108	Home care training to home care client, per 15 minutes	5	100	43,820	$140	$16.6M
T2040	Financial management, self-directed, waiver; per 15 minutes	11	40	14,910	$160	$3.5M
T1016	Case management, each 15 minutes	16	60	3,410	$120	$970.5K
T1005	Respite care services, up to 15 minutes	21	80	2,880	$70	$799.2K
T1999	Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks"	1	40	1,370	$160	$315.4K

Nearby Providers

Other providers in the same ZIP code as District 4 Cdo Program, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bowling Green-warren County Community Hospital Corporation	KY	General Acute Care Hospital	$0	$112.1M
Graves Gilbert Clinic PLLC	KY	Specialist	$0	$78M
Encore Of Bowlng Green Adhc LLC	KY	Adult Day Care Clinic/Center	$0	$23.9M
Journeypure Bowling Green LLC	KY	Substance Abuse Rehabilitation Facility	$0	$16.1M
Ky Steps LLC	KY	Community/Behavioral Health Agency	$0	$13.7M
Tj & L Consulting, LLC	KY	Community/Behavioral Health Agency	$0	$11.3M
Julie Gaskill	KY	Oral and Maxillofacial Surgery (Dentist)	$0	$8.9M
Medical Center Ems, L.L.C.	KY	Ambulance	$1.8M	$6.5M
United Seating And Mobility LLC	KY	Customized Equipment (DME)	$0	$7.3M
Commonwealth Health Corporation	KY	Adult Day Care Clinic/Center	$0	$6.8M

District 4 Cdo Program — Billing Profile & Reimbursement Data

Sign up for District 4 Cdo Program — Billing Profile & Reimbursement Data policy alerts

District 4 Cdo Program — Billing Profile & Reimbursement Data

Sign up for District 4 Cdo Program — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References