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

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

Rathburn Healthcare LLC (NPI 1255923827)

Field	Value
Entity Type	Organization
Organization	Rathburn Healthcare LLC
Address	152 W Burton Ave Ste G
City	Salt Lake City
State	UT
ZIP	84115
Taxonomy	Home Health Agency
NPI Enumerated	February 5, 2021

Payer Source	Total Paid
Medicaid	$19.1M
Medicare	$0

Key Findings

This provider is effectively single-payer in scale: RATHBURN HEALTHCARE LLC has no Medicare billing on file and reports $19.1M in lifetime Medicaid revenue, indicating its commercial footprint in Medicare is minimal to non-existent and its business is concentrated in Medicaid. Analysts should treat Medicaid as the primary revenue source when evaluating this entity.

Revenue is highly concentrated in a single service line: the precomputed top three Medicaid codes account for 100.0% of the provider's Medicaid revenue, with T1019 alone representing $18.2M (95.3% of this provider's total Medicaid revenue). T1001 and T1003 contribute $867.3K (4.5%) and $32.3K (0.2%) respectively, leaving little revenue diversification across other Medicaid codes.

The code mix and descriptions point to an operation focused on personal care rather than Medicare-style skilled episodic home health: as a Home Health Agency, RATHBURN’s dominant code T1019 (Personal care services, per 15 minutes) suggests sustained personal-care delivery under individualized plans, while T1001 (Nursing assessment / evaluation) and T1003 (LPN/LVN services, up to 15 minutes) are secondary and much smaller contributors. This profile is consistent with a provider offering ongoing in-home personal care and intermittent nursing assessments rather than a Medicare-skilled home health model.

Volume and payment profile reinforce the personal-care concentration: RATHBURN billed 40.7K claims for T1019 at $447 avg paid/claim, compared with 1K claims for T1001 at $842 avg paid/claim and 43 claims for T1003 at $751 avg paid/claim. The disparity in claim counts shows that high-volume, per-15-minute personal care drives cash flow while higher-paid assessments and LPN/LVN services are infrequent.

Competitive standing in-state is strong for its core service: T1019 ranks #2 of 29 providers in Utah and is described as 96th percentile, notably above typical state volume for this code, indicating RATHBURN is a major statewide provider of personal care services. By contrast, T1001 ranks #30 of 65 (55th percentile) and T1003 ranks #6 of 6 (0th percentile), each characterized as typical or unremarkable, so the provider’s market prominence is concentrated almost entirely in T1019.

Tenure is relatively short but with substantial Medicaid scale-up: the NPI was enumerated on 2021-02-05 (~5 years ago), so the organization achieved $19.1M in Medicaid revenue within roughly five years of registration, consistent with rapid expansion in high-volume personal-care billing. Analysts should consider growth trajectory when benchmarking against longer-established peers.

From an operational and policy perspective, the extreme revenue concentration in T1019 introduces business risk: with 95.3% of Medicaid revenue tied to one code, RATHBURN is vulnerable to rate changes, utilization-management policies, or program edits affecting personal care services. Payers and contracting teams should monitor authorization patterns, plan-of-care documentation, and state policy changes that could materially affect this single dominant revenue stream.

Payment-levels indicate that nursing assessments are higher-paid but far less frequent: T1001 pays $842 avg per claim while T1019 pays $447 avg per claim, yet T1019’s much larger claim volume (40.7K vs 1K) drives total revenue. This suggests the provider relies on frequent, lower-unit personal-care encounters supplemented by occasional higher-paid nursing evaluations, aligning with a care model that emphasizes ongoing custodial personal care with periodic clinical oversight.

Medicaid: Complete Services Breakdown

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

3 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	40,690	$450	$18.2M
T1001	Nursing assessment / evaluation	1,030	$840	$867.3K
T1003	Lpn/lvn services, up to 15 minutes	40	$750	$32.3K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Utah Distribution

Rathburn Healthcare LLC — 1 of 3 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. Utah median

3 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	2	30	6,130	$110	$1.1M
T1003	Lpn/lvn services, up to 15 minutes	6	10	720	$530	$812.7K
T1001	Nursing assessment / evaluation	30	70	700	$80	$603.4K

Nearby Providers

Other providers in the same ZIP code as Rathburn Healthcare LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Abs Utah, P.C.	UT	Community/Behavioral Health Agency	$0	$197.1M
Acorn Care LLC	UT	In Home Supportive Care Agency	$0	$28.3M
Granite School District	UT	Local Education Agency (LEA)	$0	$10.7M
Salt Lake Homecare	UT	Home Health Agency	$0	$8.7M
Norco, Inc.	UT	Durable Medical Equipment & Medical Supplies	$0	$8M
City Of South Salt Lake	UT	Land Ambulance	$93.1K	$6.7M
Care Advocates LLC	UT	Case Management Agency	$0	$6.2M
Advocates For Independence LLC	UT	Case Management Agency	$0	$5.9M
Discovery House Utah, Inc.	UT	Methadone Clinic	$132.4K	$4.7M
Duramed LLC	UT	Durable Medical Equipment & Medical Supplies	$0	$4.1M

Rathburn Healthcare LLC — Billing Profile & Reimbursement Data

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Rathburn Healthcare LLC — 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