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

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

Tri-county Group Xv, Inc. (NPI 1316097157)

Field	Value
Entity Type	Organization
Organization	Tri-county Group Xv, Inc.
Address	209 Slicer St
City	Kennett
State	MO
ZIP	63857
Taxonomy	Home Health Agency
NPI Enumerated	January 12, 2007

Payer Source	Total Paid
Medicaid	$113.1M
Medicare	$0

Key Findings

This provider is effectively single‑payer: there is no Medicare billing on file and all recorded government revenue is Medicaid, totaling $113.1M. The absence of Medicare activity indicates TRI-COUNTY GROUP XV, INC. operates with a Medicaid-centric business model rather than a mixed Medicare/Medicaid portfolio.

Revenue is extremely concentrated in a very small set of service codes: T1019 accounts for $105.5M (93.2% of the provider’s Medicaid revenue) and T1001 accounts for $7.6M (6.8% of Medicaid revenue), and the precomputed top three codes together account for 100.0% of Medicaid revenue. This concentration indicates the provider’s financial performance is highly dependent on a few time‑based home care and assessment services.

The code mix points to a labor‑intensive personal care and assessment operation: T1019 (personal care services, per 15 minutes) and T1001 (nursing assessment/evaluation) are the dominant billing lines, consistent with a home health/home care agency that focuses on in‑home personal support and initial/ongoing nursing evaluations. Those service definitions suggest operations centered on high‑frequency, time‑tracked caregiver visits and formal nursing assessments rather than episodic skilled nursing or durable medical equipment.

Claim volumes underline a very large operational footprint for these services: T1019 shows 1.8M claims with a $60 avg paid/claim and T1001 shows 159.3K claims with a $48 avg paid/claim. These high claim counts are indicative of a high‑volume care delivery model that is personnel‑intensive and likely requires substantial scheduling, travel, and payroll infrastructure to support frequent short‑duration visits.

State competitive standing is dominant for the two revenue drivers: T1019 ranks #5 of 1332 providers in-state and is labeled an extreme outlier at the 100th percentile, and T1001 ranks #1 of 417 providers in-state and is also an extreme outlier at the 100th percentile. Those rankings indicate TRI-COUNTY GROUP XV, INC. is a major, outlier provider of personal care and nursing assessment services within its state peer set.

There is material business risk from the concentrated revenue mix: because $105.5M (93.2%) of Medicaid revenue is tied to T1019, changes in reimbursement policy, audit focus, or utilization for that code could disproportionately affect overall revenue. Diversification away from a single high‑share code appears limited based on the reported top codes.

Several additional codes appear in the dataset but contribute no recorded Medicaid revenue: S5130 (400 claims, $0 avg paid/claim, $0 revenue), S5150 (1.9K claims, $0 avg paid/claim, $0 revenue), and T1028 (105 claims, $0 avg paid/claim, $0 revenue). The presence of claims with $0 paid/claim suggests these lines are either non‑reimbursed, bundled, administrative, or otherwise not revenue‑generating under current state payment rules, and they do not materially offset the revenue concentration in T1019/T1001.

The provider’s NPI was enumerated on 2007-01-12 (~19 years ago), indicating an established presence in the market; when combined with $113.1M in lifetime Medicaid revenue and extreme outlier rankings on key codes, this longevity supports a picture of a long‑standing, Medicaid‑focused home health agency with substantial scale in time‑based personal care and assessment services.

Medicaid: Complete Services Breakdown

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

5 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…	1,757,910	$60	$105.5M
T1001	Nursing assessment / evaluation	159,340	$50	$7.6M
S5130	Homemaker service, nos; per 15 minutes	400	$0	$0
S5150	Unskilled respite care, not hospice; per 15 minutes	1,910	$0	$0
T1028	Assessment of home, physical and family environment, to determine suitability to meet patient's medical needs	110	$0	$0

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Missouri Distribution

Tri-county Group Xv, Inc. — 2 of 2 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Missouri

Full comparison — all codes billed, vs. Missouri median

5 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…	5	1,330	6,550	$80	$4.6M
S5150	Unskilled respite care, not hospice; per 15 minutes	131	220	3,750	$60	$1.3M
T1001	Nursing assessment / evaluation	1	420	1,610	$50	$378.4K
S5130	Homemaker service, nos; per 15 minutes	76	90	3,300	$30	$317.1K
T1028	Assessment of home, physical and family environment, to determine suitability to meet patient's medical needs	50	90	150	$90	$164.6K

Nearby Providers

Other providers in the same ZIP code as Tri-county Group Xv, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Family Counseling Center, Inc	MO	Community/Behavioral Health Agency	$0	$284.1M
Bootheel Area Independent Living Services, Inc.	MO	Home Health Agency	$0	$58.9M
Visiting Nurse Association Of Southeast Missouri Inc	MO	Home Health Agency	$0	$26.1M
Hope@home LLC	MO	Home Health Agency	$0	$6.2M
Crosstree Healthcare LLC	MO	Assisted Living Facility	$0	$5.5M
Visiting Nurse Association Of Southeast Missouri Inc	MO	Home Health Agency	$0	$4.6M
Visiting Nurse Association Of Southeast Missouri Inc	MO	Home Health Agency	$0	$4.5M
Dunklin Day Activity Center	MO	Developmentally Disabled Services Day Training Agency	$0	$3.9M
Jackie Sutherland	MO	Internal Medicine Physician	$101.3K	$162.4K
Dave Jain	MO	Internal Medicine Physician	$207.1K	$0

Tri-county Group Xv, Inc. — Billing Profile & Reimbursement Data

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Tri-county Group Xv, 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