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

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

Specialized Community Care, Inc (NPI 1275651267)

Field	Value
Entity Type	Organization
Organization	Specialized Community Care, Inc
Address	3627 Route 7 S
City	Middlebury
State	VT
ZIP	05753
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	March 27, 2007

Payer Source	Total Paid
Medicaid	$60.9M
Medicare	$0

Key Findings

SPECIALIZED COMMUNITY CARE, INC is effectively a Medicaid-only billing entity in the dataset: it has no Medicare billing on file and reports $60.9M in lifetime Medicaid revenue, which means analysts should treat its public payment footprint as single‑payer Medicaid dominated. This concentration implies that Medicaid policy, rates, and waiver arrangements will drive its financial performance more than Medicare relationships.

Revenue is extremely concentrated across a very small set of Medicaid codes: the precomputed top 3 Medicaid codes account for 100.0% of this provider’s total Medicaid revenue, with 99199 representing 66.6% and H2022 representing 33.4% of total Medicaid revenue. That degree of concentration indicates that a small number of service lines or billing constructs generate essentially all recorded Medicaid dollars for this provider.

The code mix and descriptions point to community behavioral‑health and wraparound operations as the core business lines: 99199 (other medicine services or procedures) generated $40.5M from 3.8K claims at $10636 avg paid/claim, and H2022 (community-based wrap-around services, per diem) generated $20.4M from 5.6K claims at $3667 avg paid/claim. Together these codes suggest the organization bills for high‑value, non‑standardized service packages and per‑diem wraparound supports typical of community/behavioral health agencies.

Competitive standing on its top revenue codes is modest within Vermont: 99199 ranks #10 of 16 providers (40th percentile) and H2022 ranks #10 of 14 providers (31th percentile), both labeled “typical, unremarkable volume.” Those rankings indicate the provider is not a statewide leader for these specific codes and instead occupies a middle-to-lower tier position relative to in‑state peers.

Multiple frequently reported codes show high claim counts but $0 avg paid/claim and $0 revenue (examples include T1016 with 31.5K claims, T2021 with 10.1K claims, S5150 with 9.4K claims, and S5151 with 1.4K claims). This pattern is consistent with substantial non‑fee‑for‑service or encounter reporting (for waiver, encounter, or zero‑dollar reporting categories) and should prompt payers and analysts to review whether these are encounter submissions, bundled payments, or administrative/eligibility reporting rather than direct fee‑for‑service revenue lines.

Operationally, the provider records very high volumes in care coordination and habilitation reporting (for example T1016 case management at 31.5K claims and T2021 day habilitation at 10.1K claims) even though those lines show $0 paid in the file. This suggests a sizable delivery footprint of non‑reimbursed or capitated/waiver services that could represent a large operational caseload not reflected in Medicaid fee‑for‑service revenue totals.

From a contracting and payer‑management perspective, the organization’s reliance on two revenue drivers—99199 and H2022—creates negotiating leverage tied to how those codes are defined and paid. Because 99199 carries a very high avg paid/claim ($10636) and dominates revenue, payers should pay particular attention to service definitions, authorization controls, and rate-setting for non‑specific “other medicine” billing when assessing network value and cost risk.

The provider has an established presence in the market, with an NPI enumeration date of 2007-03-27 (~19 years ago), which indicates long tenure that may correspond to stable local relationships and experience delivering community behavioral health and wraparound services. Longevity combined with revenue concentration suggests the organization has institutionalized billing practices around a narrow set of Medicaid service constructs rather than a broad Medicare/Medicaid product mix.

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
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	3,810	$10,640	$40.5M
H2022	Community-based wrap-around services, per diem	5,560	$3,670	$20.4M
S0215	Non-emergency transportation; mileage, per mile	550	$0	$0
S5150	Unskilled respite care, not hospice; per 15 minutes	9,440	$0	$0
T1016	Case management, each 15 minutes	31,490	$0	$0
S5140	Foster care, adult; per diem	1,170	$0	$0
S5151	Unskilled respite care, not hospice; per diem	1,450	$0	$0
T2016	Habilitation, residential, waiver; per diem	630	$0	$0
T2021	Day habilitation, waiver; per 15 minutes	10,060	$0	$0

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Vermont Distribution

Specialized Community Care, Inc — 0 of 2 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Vermont

Full comparison — all codes billed, vs. Vermont median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99199	Use this code to report other medicine services or procedures for which there is no specific code available.	10	20	6,570	$6,270	$59.7M
H2022	Community-based wrap-around services, per diem	10	10	18,970	$620	$35.6M
T1016	Case management, each 15 minutes	9	40	3,900	$1	$31.1K
T2021	Day habilitation, waiver; per 15 minutes	11	10	28,170	$1	$210
S0215	Non-emergency transportation; mileage, per mile	2	10	3,630	$0	$0
S5150	Unskilled respite care, not hospice; per 15 minutes	11	10	27,240	$0	$0
S5140	Foster care, adult; per diem	11	10	60,820	$0	$0
S5151	Unskilled respite care, not hospice; per diem	11	10	8,650	$0	$0
T2016	Habilitation, residential, waiver; per diem	12	10	17,170	$0	$0

Nearby Providers

Other providers in the same ZIP code as Specialized Community Care, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Counseling Service Of Addison County	VT	Developmental Disabilities Clinic/Center	$0	$59.6M
Counseling Service Of Addison County, Inc	VT	Clinic/Center	$0	$22.1M
Middlebury Pediatric Dentistry, PLLC	VT	Pediatric Dentistry	$0	$2.9M
Rainbow Pediatrics	VT	Pediatric Adolescent Medicine Physician	$0	$1.8M
Middlebury Volunteer Ambulance Association, Inc	VT	Ambulance	$508.9K	$1.3M
Porter Hospital, Inc	VT	Family Medicine Physician	$0	$1.3M
Brian Collins	VT	Pediatric Dentistry	$0	$606.8K
Middlebury Family Health	VT	Health Maintenance Organization	$0	$547.3K
Amy Gregory	VT	Ophthalmology Physician	$306.6K	$0
Elizabeth Keathley	VT	Clinical Psychologist	$0	$303.3K

Specialized Community Care, Inc — Billing Profile & Reimbursement Data

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Specialized Community Care, 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

Nearby Providers

Frequently Asked Questions

References