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.

Kentucky River Community Care, Inc (NPI 1316061658)

Field	Value
Entity Type	Organization
Organization	Kentucky River Community Care, Inc
Address	115 Rockwood Ln
City	Hazard
State	KY
ZIP	41701
Taxonomy	Specialist
NPI Enumerated	March 19, 2007

Payer Source	Total Paid
Medicaid	$109.1M
Medicare	$0

Key Findings

KENTUCKY RIVER COMMUNITY CARE, INC reports no Medicare billing on file and $109.1M in lifetime Medicaid revenue, making it effectively a single‑payer (Medicaid) operator at this scale rather than a mixed Medicare/Medicaid provider. Analysts should treat Medicaid as the dominant and sole public-payer exposure when evaluating reimbursement risk and network strategy for this entity.

Revenue at this provider is highly concentrated: the precomputed top three Medicaid codes account for 81.6% of its total Medicaid revenue. Those top codes are T1019 (304.3K claims, $125 avg paid/claim, $38M revenue, 34.8% of Medicaid revenue), T2016 (129.2K claims, $241 avg paid/claim, $31.1M revenue, 28.5% of Medicaid revenue), and 97535 (218.2K claims, $91 avg paid/claim, $19.9M revenue, 18.2% of Medicaid revenue).

The service mix implied by the highest‑revenue codes points to a workforce‑ and facility‑intensive community long‑term services and supports footprint: T1019 is personal care services billed in 15‑minute units, T2016 is habilitation residential waiver per diem, and 97535 reflects therapy/instructional services. Combined with material volumes in day habilitation, case management, home care training, and respite codes, the profile is consistent with a provider focused on Medicaid home‑ and community‑based services (HCBS) and residential habilitation programs rather than acute or physician specialty care.

For T1019 (personal care services) the provider ranks #6 of 51 providers in-state and sits in the 90th percentile with a descriptor of "notably above typical state volume," indicating this organization is a major regional supplier of minute‑based personal care relative to peers. That outsized position for a single code (34.8% of the provider’s Medicaid revenue) suggests operational scale in caregiver deployment and billing administrative capacity for high-frequency services.

T2016 (habilitation, residential, waiver) and 97535 (therapeutic instruction) also show high absolute volumes compared with peers — T2016 ranks #14 of 146 (91th percentile) and 97535 ranks #11 of 305 (97th percentile) — yet both are labeled as "typical, unremarkable volume" for their code categories. This combination of high percentile placement with the given label suggests the provider captures large shares of expected waiver and therapy demand in-state without showing atypical statistical behavior for those service types.

Several ancillary Medicaid codes show meaningful contributions and selective outlier status: T1005 (respite care) produced $2.9M and ranks #5 of 81 providers in-state (95th percentile; "notably above typical state volume"), while case management (T2022), day habilitation (T2021), home care training (S5108), and financial management (T2040) each add diversification to the revenue base. Together these secondary codes demonstrate the provider operates across multiple waiver and HCBS service lines even though overall Medicaid revenue remains concentrated in the top three codes.

The provider’s NPI enumeration date of 2007-03-19 (~19 years ago) indicates a long tenure in the market; combined with $109.1M in Medicaid lifetime revenue and high rankings on key waiver and personal care codes, this points to an established, entrenched regional operator in Kentucky’s Medicaid HCBS/residential habilitation ecosystem. For payers and competitors, that tenure plus concentrated scale suggests durable sourcing relationships and operational experience to consider in network contracting or capacity assessments.

Medicaid: Complete Services Breakdown

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

13 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…	304,250	$130	$38M
T2016	Habilitation, residential, waiver; per diem	129,170	$240	$31.1M
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	218,170	$90	$19.9M
T2022	Case management, per month	24,180	$220	$5.3M
T2021	Day habilitation, waiver; per 15 minutes	66,960	$80	$5M
S5108	Home care training to home care client, per 15 minutes	49,080	$90	$4.4M
T1005	Respite care services, up to 15 minutes	50,600	$60	$2.9M
T2040	Financial management, self-directed, waiver; per 15 minutes	26,020	$90	$2.2M
S5130	Homemaker service, nos; per 15 minutes	6,010	$50	$270.3K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	100	$40	$3.5K

Showing 1–10 of 13

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

Kentucky River Community Care, Inc — 1 of 13 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

13 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	47	100	43,820	$140	$16.6M
T2016	Habilitation, residential, waiver; per diem	14	150	42,680	$190	$11.3M
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…	6	50	13,600	$140	$11.1M
T2022	Case management, per month	12	80	7,120	$290	$4.1M
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	11	310	830	$120	$3.7M
T2040	Financial management, self-directed, waiver; per 15 minutes	12	40	14,910	$160	$3.5M
T2021	Day habilitation, waiver; per 15 minutes	14	150	16,130	$70	$1.7M
T1005	Respite care services, up to 15 minutes	5	80	2,880	$70	$799.2K
90887	In this service, the provider interprets or explains the results of psychiatric exams, medical exams, other procedures, or information about the patient’s care to the patient’s family members or…	133	140	460	$70	$475.2K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	1,256	1,270	760	$80	$447.2K

Showing 1–10 of 13

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Appalachian Regional Healthcare, Inc.	KY	General Acute Care Hospital	$0	$107.9M
Kentucky River Community Care, Inc	KY	Mental Health Counselor	$0	$104M
Kentucky River Area Dev Dist	KY	Supports Brokerage Agency	$0	$43.4M
Primary Care Centers Of Eastern Kentucky, LLC	KY	Rural Health Clinic/Center	$0	$26.2M
Soaring Potentials Lllp	KY	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$20.4M
Bhg Xxvi, LLC	KY	Substance Use Disorder Rehabilitation Clinic/Center	$493.7K	$16.1M
Southern Medical Partners, LLC	KY	Emergency Medicine Physician	$0	$15.6M
Dungarvin Kentucky, LLC - Hazard	KY	Developmentally Disabled Services Day Training Agency	$0	$10.1M
Quantum Healthcare Associates Inc	KY	General Practice Physician	$0	$9.1M
Community Alternatives Kentucky, Inc.	KY	Case Management Agency	$0	$7.6M

Kentucky River Community Care, Inc — Billing Profile & Reimbursement Data

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Kentucky River 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