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

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

Community Options, Inc. (NPI 1295139871)

Field	Value
Entity Type	Organization
Organization	Community Options, Inc.
Address	2815 Patriot Way
City	Nashville
State	TN
ZIP	37214
Taxonomy	Intellectual and/or Developmental Disabilities Residential Treatment Facility
NPI Enumerated	October 10, 2014

Payer Source	Total Paid
Medicaid	$27.4M
Medicare	$0

Key Findings

COMMUNITY OPTIONS, INC. is effectively a Medicaid-focused provider: it has no Medicare billing on file and reports $27.4M in lifetime Medicaid revenue, and its NPI was enumerated on 2014-10-10 (~12 years ago), indicating an established presence in the market since that enrollment date. This single-payer skew should inform analyses of payer risk and revenue sensitivity for this entity.

Revenue is highly concentrated in a very small set of services: the precomputed top three Medicaid codes account for 98.0% of the provider's total Medicaid revenue. This concentration implies the organization’s financial performance depends heavily on reimbursement and utilization for a narrow set of residential and habilitation services.

The provider’s code mix (dominant use of T2033 and T2016, supported by ABA codes 97153 and 97155) indicates an operational focus on residential and waiver-based habilitation services for individuals with intellectual and developmental disabilities. T2033 (Residential care, waiver; per diem) and T2016 (Habilitation, residential, waiver; per diem) are per-diem residential payments, while 97153 and 97155 reflect adaptive behavior treatment delivered by technicians and supervised QHPs, showing a blended model of residential housing plus on-site behavioral therapy.

T2033 is the single largest revenue driver: 24.2K claims, $811 avg paid/claim, $19.6M revenue, representing 71.7% of the provider's Medicaid revenue. It ranks #11 of 97 providers in-state (90th percentile) and is characterized in the data as having "typical, unremarkable volume," which together suggests a strong but industry-typical foothold in residential waiver per-diem billing rather than an outlier market position.

T2016 is the second major contributor with 5.5K claims, $1158 avg paid/claim, $6.4M revenue, representing 23.3% of Medicaid revenue; it ranks #13 of 45 in-state (73th percentile) and is also labeled "typical, unremarkable volume." This pattern reinforces that most Medicaid revenue is driven by complementary per-diem residential and habilitation waivers rather than episodic clinical services.

Adaptive behavior services appear as a secondary revenue stream: 97153 generated 6.4K claims, $131 avg paid/claim, $838K revenue (3.1% of total), ranking #11 of 62 in-state (84th percentile), while 97155 produced 1.3K claims, $162 avg paid/claim, $216.3K revenue (0.8% of total), ranking #9 of 46 (82th percentile). Both codes are characterized as "typical, unremarkable volume," indicating the provider offers ABA-style services on-site but that these services are not the primary revenue center.

From a competitive standpoint within Tennessee the organization is a meaningful participant in residential waiver billing—notably holding a top-decile rank on T2033—yet its overall market position is modest because the business is narrowly concentrated in a few codes. That concentration (98.0% in the top three codes) also creates exposure to policy or rate changes affecting waiver per-diem payments, making monitoring of state waiver policy and per-diem rates particularly material for payers and provider network managers.

Medicaid: Complete Services Breakdown

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

6 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2033	Residential care, not otherwise specified (nos), waiver; per diem	24,220	$810	$19.6M
T2016	Habilitation, residential, waiver; per diem	5,510	$1,160	$6.4M
97153	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	6,400	$130	$838K
T2021	Day habilitation, waiver; per 15 minutes	4,020	$80	$317.5K
97155	The provider, a physician or other qualified healthcare professional, administers adaptive behavior treatment face–to–face with one patient and makes modifications in the protocol targets and…	1,340	$160	$216.3K
S0315	Disease management program; initial assessment and initiation of the program	20	$220	$3.5K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Tennessee Distribution

Community Options, Inc. — 0 of 6 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Tennessee

Full comparison — all codes billed, vs. Tennessee median

6 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2033	Residential care, not otherwise specified (nos), waiver; per diem	11	100	4,520	$320	$31.6M
T2016	Habilitation, residential, waiver; per diem	13	50	2,620	$430	$11.9M
T2021	Day habilitation, waiver; per 15 minutes	50	100	3,920	$80	$3.4M
97153	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	11	60	1,760	$170	$564.2K
97155	The provider, a physician or other qualified healthcare professional, administers adaptive behavior treatment face–to–face with one patient and makes modifications in the protocol targets and…	9	50	440	$120	$89.7K
S0315	Disease management program; initial assessment and initiation of the program	7	10	50	$370	$18.8K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Green Care Homes Of Tennessee, LLC	TN	In Home Supportive Care Agency	$0	$4.3M
180 Health Partners , Inc	TN	Clinical Social Worker	$0	$3.2M
Nicole Page	TN	Family Nurse Practitioner	$1.2M	$0
Anayston Casey	TN	Occupational Therapist	$62.7K	$0
Lisa Wigton	TN	Physical Therapist	$60.5K	$0
Alexandre Koumtchev	TN	Psychiatry Physician	$57.8K	$0
Lakiesha Bennett	TN	Primary Care Nurse Practitioner	$29.9K	$0
Ethan Brouillette	TN	Physician Assistant	$26.2K	$0
Brendan Lucas	TN	Physician Assistant	$14.1K	$0
Jeffrey Barton	TN	Physical Therapist	$4.7K	$0

Community Options, Inc. — Billing Profile & Reimbursement Data

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Community Options, 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