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

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

Utah Case Management (NPI 1316319197)

Field	Value
Entity Type	Organization
Organization	Utah Case Management
Address	13691 S Brown Farm Ln
City	Draper
State	UT
ZIP	84020
Taxonomy	Case Management Agency
NPI Enumerated	October 20, 2015

Payer Source	Total Paid
Medicaid	$13.3M
Medicare	$0

Key Findings

UTAH CASE MANAGEMENT is effectively a Medicaid-only billing entity: it has no Medicare billing on file and reports $13.3M in lifetime Medicaid revenue. The organization’s NPI was enumerated on 2015-10-20 (≈11 years ago), indicating an established presence in the state waiver/case-management market.

Revenue is highly concentrated in a very small set of services: the top three Medicaid codes (T1016, T2024, T2038) account for 99.8% of the provider’s total Medicaid revenue. Specifically, T1016 represents $10.3M (77.8%), T2024 $2.4M (18.4%), and T2038 $479.6K (3.6%) of the $13.3M total, showing near-total dependence on a narrow menu of waiver and case-management services.

The service mix (dominance of T1016 — Case management, each 15 minutes — with 224.9K claims and $46 avg paid/claim, plus T2024 — Service assessment/plan of care development, waiver — with 19.5K claims and $125 avg paid/claim) indicates the operation is centered on ongoing, time-based case management and waiver plan development rather than fee-for-service clinical procedures. This pattern points to a business model built around high-volume care coordination and administrative waiver functions.

UTAH CASE MANAGEMENT is a clear statewide market leader on its top codes: it ranks #1 of 18 providers for T1016 and #1 of 13 providers for T2024, with both codes noted as 100th percentile and labeled an "extreme outlier." These rankings indicate dominant volume share in Utah for routine case management and waiver assessment services, suggesting strong competitive positioning within those lines.

T2038 (Community transition, waiver; per service) also ranks #1 of 4 providers and is 100th percentile but is described as "typical, unremarkable volume for this code"; its absolute contribution is modest at $479.6K (3.6%). In practice this means leadership on T2038 exists but does not drive the same revenue scale or signal the same level of concentration risk as T1016 and T2024.

Several ancillary codes appear at de minimis levels: T2017 (Habilitation, residential, waiver; 15 minutes) contributes $26.7K (0.2%) and ranks #1 of 1 providers with no state peer comparison, while T2004 (Non-emergency transport; multi-pass) contributes $3.7K (0.0%) and ranks #2 of 2 providers. These small lines suggest limited involvement in residential habilitation and transport relative to the provider’s core case-management business.

For payers and analysts, the profile signals operational and reimbursement sensitivity to changes in Medicaid waiver policy or rate-setting for T1016 and T2024: with 99.8% of revenue concentrated in those top three codes and the largest two labeled "extreme outlier," any policy, utilization, or audit shifts affecting time-based case management or waiver assessments could materially affect the provider’s revenue. Monitoring state waiver contract activity and utilization trends for T1016 and T2024 should be a priority when assessing ongoing financial or network risk.

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
T1016	Case management, each 15 minutes	224,880	$50	$10.3M
T2024	Service assessment/plan of care development, waiver	19,520	$130	$2.4M
T2038	Community transition, waiver; per service	690	$690	$479.6K
T2017	Habilitation, residential, waiver; 15 minutes	780	$30	$26.7K
T2004	Non-emergency transport; commercial carrier, multi-pass	110	$30	$3.7K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Utah Distribution

Utah Case Management — 3 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. Utah median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2004	Non-emergency transport; commercial carrier, multi-pass	2	10	99,300	$40	$3.9M
T1016	Case management, each 15 minutes	1	20	3,150	$70	$1.6M
T2024	Service assessment/plan of care development, waiver	1	10	150	$130	$260.7K
T2038	Community transition, waiver; per service	1	10	20	$670	$126.7K
T2017	Habilitation, residential, waiver; 15 minutes	1	10	780	$30	$26.6K

Nearby Providers

Other providers in the same ZIP code as Utah Case Management, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Beechtree Diagnostics LLP	UT	Clinical Medical Laboratory	$1M	$34.7M
Lone Peak Hospital, Inc.	UT	General Acute Care Hospital	$0	$4.1M
After Hours Medical LLC	UT	Urgent Care Clinic/Center	$0	$3.2M
Rocky Mountain Laboratories LLC	UT	Clinical Medical Laboratory	$224.5K	$2.1M
Utnv Draper Operator, LLC	UT	Assisted Living Facility	$0	$2.2M
Beechtree Molecular Lab LLC	UT	Clinical Medical Laboratory	$236.8K	$862.7K
Draper City	UT	Ambulance	$115.3K	$978.1K
Spencer Hardenbrook	UT	Family Medicine Physician	$965.5K	$3.7K
Jeffrey Welch	UT	General Practice Dentistry	$0	$856.8K
Utah Surgery Center LP	UT	Ambulatory Surgical Clinic/Center	$473.4K	$337.9K

Utah Case Management — Billing Profile & Reimbursement Data

Sign up for Utah Case Management — Billing Profile & Reimbursement Data policy alerts

Utah Case Management — Billing Profile & Reimbursement Data

Sign up for Utah Case Management — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References