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

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

Optumrx, Inc. (NPI 1336736115)

Field	Value
Entity Type	Organization
Organization	Optumrx, Inc.
Address	11020 Optum Cir
City	Eden Prairie
State	MN
ZIP	55344
Taxonomy	Durable Medical Equipment & Medical Supplies
NPI Enumerated	December 28, 2020

Payer Source	Total Paid
Medicaid	$18.5M
Medicare	$0

Medicaid: Complete Services Breakdown

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

44 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
A9999	Miscellaneous dme supply or accessory, not otherwise specified	334,760	$20	$6M
B4150	Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100…	42,730	$70	$3M
B4154	Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or…	32,730	$90	$3M
B4152	Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include…	15,920	$90	$1.4M
T4535	Disposable liner/shield/guard/pad/undergarment, for incontinence, each	21,360	$50	$1.2M
A4554	Disposable underpads, all sizes	13,660	$60	$833.4K
A4335	Incontinence supply; miscellaneous	40,500	$10	$567K
A4927	Gloves, non-sterile, per 100	25,450	$20	$432.6K
T4527	Adult sized disposable incontinence product, protective underwear/pull-on, large size, each	6,200	$60	$353.4K
A6250	Skin sealants, protectants, moisturizers, ointments, any type, any size	20,800	$10	$228.8K

Showing 1–10 of 44

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Minnesota Distribution

Optumrx, Inc. — 11 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Minnesota

Full comparison — all codes billed, vs. Minnesota median

44 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T4527	Adult sized disposable incontinence product, protective underwear/pull-on, large size, each	6	60	690	$90	$881.5K
A9999	Miscellaneous dme supply or accessory, not otherwise specified	1	10	3,400	$20	$848.6K
T4535	Disposable liner/shield/guard/pad/undergarment, for incontinence, each	4	60	880	$50	$807.7K
T4528	Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each	8	60	580	$110	$788.9K
T4540	Incontinence product, protective underpad, reusable, chair size, each	2	10	33,610	$20	$726.1K
E0240	Bath/shower chair, with or without wheels, any size	1	10	2,270	$360	$685.8K
B4154	Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or…	1	10	410	$120	$515.6K
A4554	Disposable underpads, all sizes	2	10	190	$20	$466.8K
T4525	Adult sized disposable incontinence product, protective underwear/pull-on, small size, each	5	20	210	$80	$372.2K
B4152	Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include…	1	20	1,280	$140	$362.4K

Showing 1–10 of 44

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ear Professionals International LLC	MN	Hearing Aid Equipment	$0	$32.4M
Psi Pride Institute Inc	MN	Substance Abuse Rehabilitation Facility	$0	$15.6M
Pioneer Care LLC	MN	Assisted Living Facility	$0	$13.9M
Group Health, Inc.	MN	Clinical Medical Laboratory	$2.4M	$11.5M
Consulting Radiologists, Ltd	MN	Diagnostic Radiology Physician	$0	$10.3M
Sidky Family Dentistry	MN	General Practice Dentistry	$0	$6.3M
Taylor Jordan	MN	Diagnostic Radiology Physician	$545.8K	$0
Ann Marie Equio	MN	Family Nurse Practitioner	$512.2K	$0
Shawn Ahmed	MN	Diagnostic Radiology Physician	$505K	$0
David Winger	MN	Diagnostic Radiology Physician	$413.8K	$1.6K

Optumrx, Inc. — Billing Profile & Reimbursement Data

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Optumrx, Inc. — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References