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

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

Royal Journeys LLC (NPI 1265556435)

Field	Value
Entity Type	Organization
Organization	Royal Journeys LLC
Address	1497 Curlew Dr
City	Ammon
State	ID
ZIP	83406
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	March 16, 2007

Payer Source	Total Paid
Medicaid	$38.3M
Medicare	$0

Key Findings

This provider is effectively a single‑payer Medicaid operation: Medicare billing is none (no Medicare billing on file) while total Medicaid revenue is $38.3M. The absence of Medicare claims means the organization’s financial performance and payer risk are almost entirely tied to state Medicaid policy and contracts.

Revenue is highly concentrated in a narrow set of services: the precomputed top 3 Medicaid codes (H0004, 97537, H2032) account for 65.2% of the provider’s Medicaid revenue. Individually these codes generate $12.7M (H0004, 33.3%), $6.5M (97537, 16.9%), and $5.7M (H2032, 15.0%), signaling that a small number of service lines drive the majority of cash flow.

The mix of high‑volume codes describes a day‑training and community reintegration operation aligned with the provider’s taxonomy (Developmentally Disabled Services Day Training Agency): H0004 is behavioral health counseling and therapy, 97537 is community work reintegration training, and H2032 is activity therapy. Large claim counts across these time‑based, per‑15‑minute codes indicate intensive, recurring direct‑service minutes delivered in day‑program or community settings rather than episodic medical procedures.

Competitive standing in the state shows dominance on several core codes: H0004 ranks #2 of 157 providers (99th percentile; labeled an extreme outlier), while 97537 and H2032 both rank #1 of 41 providers (100th percentile; extreme outliers). Those ranks indicate this provider is a major, above‑typical performer statewide for the primary services that generate its revenue.

Several other day‑service codes further reinforce scale in non‑medical supports: S5100 (day care services) generated $4.6M (12.0%) and ranks #1 of 37 providers (100th percentile; extreme outlier), and H2023 (supported employment) generated $3M (7.9%) but is characterized as a typical volume within a very small peer set (rank #1 of 3, 100th percentile; typical, unremarkable volume). This combination shows both broad dominance in high‑volume categories and the caveat that some rank‑1 positions reflect small peer pools.

The provider maintains meaningful secondary revenue streams beyond the top three: H2019 ($2.3M, 6.1%), H2015 ($1.3M, 3.5%), H0032 ($232.5K, 0.6%), and T1027 ($198.5K, 0.5%) are all reported at levels that are described as notably above typical or above typical statewide. While none of these individually approach the top three, together they provide diversification within the Medicaid behavioral and developmental services portfolio.

The organization has been active for a sustained period: NPI enumerated 2007-03-16 (~19 years ago). That longevity, combined with concentrated high volumes on state‑covered day and behavioral service codes, suggests an established operational footprint in Idaho’s developmental disability service market.

Because $38.3M of revenue is driven almost entirely by Medicaid and the top 3 codes represent 65.2% of that revenue, changes in state reimbursement, eligibility, or program rules for H0004, 97537, or H2032 would have outsized impact on the business. Analysts should view payer‑policy risk and state program contracting as the primary financial vulnerability given the lack of Medicare diversification.

Medicaid: Complete Services Breakdown

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

16 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0004	Behavioral health counseling and therapy, per 15 minutes	110,730	$120	$12.7M
97537	In this procedure, the provider works one on one with a patient to provide community work reintegration training. The training helps the injured or ill patient to return to employment and the…	294,470	$20	$6.5M
H2032	Activity therapy, per 15 minutes	204,400	$30	$5.7M
S5100	Day care services, adult; per 15 minutes	199,150	$20	$4.6M
H2023	Supported employment, per 15 minutes	43,450	$70	$3M
H2019	Therapeutic behavioral services, per 15 minutes	22,160	$110	$2.3M
H2015	Comprehensive community support services, per 15 minutes	21,560	$60	$1.3M
96152	N/A	11,950	$60	$692.8K
H2011	Crisis intervention service, per 15 minutes	2,470	$180	$434.2K
H2014	Skills training and development, per 15 minutes	2,540	$110	$268.9K

Showing 1–10 of 16

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Royal Journeys LLC — 9 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

16 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2023	Supported employment, per 15 minutes	1	10	22,980	$80	$2.2M
H0004	Behavioral health counseling and therapy, per 15 minutes	2	160	4,020	$140	$1.6M
H2032	Activity therapy, per 15 minutes	1	40	19,190	$50	$1.6M
97537	In this procedure, the provider works one on one with a patient to provide community work reintegration training. The training helps the injured or ill patient to return to employment and the…	1	40	30,150	$20	$1.2M
H2014	Skills training and development, per 15 minutes	28	60	2,500	$60	$613.3K
H2019	Therapeutic behavioral services, per 15 minutes	3	60	2,960	$120	$609.8K
96152	N/A	11	70	2,270	$80	$608.8K
S5100	Day care services, adult; per 15 minutes	1	40	9,710	$30	$577.7K
H2015	Comprehensive community support services, per 15 minutes	2	50	2,960	$100	$570.3K
T1005	Respite care services, up to 15 minutes	2	10	1,590	$80	$123.7K

Showing 1–10 of 16

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Just 4 Kids Pediatrics	ID	Pediatrics Physician	$0	$10.8M
Qualicare Inc.	ID	Nursing Care Agency	$0	$10.3M
Pearl Health Clinic	ID	Mental Health Counselor	$0	$9.9M
4 Pillars Of Success LLC	ID	Multi-Specialty Clinic/Center	$0	$8M
A Childs Smile	ID	Pediatric Dentistry	$0	$4.4M
4 Pillars Of Success LLC	ID	Psychologist	$0	$3.3M
Lincare Inc.	ID	Durable Medical Equipment & Medical Supplies	$0	$2M
Darryl Moffett	ID	Ophthalmology Physician	$2M	$0
Idaho Falls Pediatric Dentistry, PLLC	ID	Pediatric Dentistry	$0	$1.2M
4 Pillars Of Success LLC	ID	Clinic/Center	$0	$697.9K

Royal Journeys 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