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

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

Option Care Enterprises, Inc. (NPI 1346270527)

Field	Value
Entity Type	Organization
Organization	Option Care Enterprises, Inc.
Address	870 N. Arlington Heights Rd
City	Itasca
State	IL
ZIP	60143
Taxonomy	Home Infusion Therapy Pharmacy
NPI Enumerated	July 4, 2006

Payer Source	Total Paid
Medicaid	$45.6M
Medicare	$0

Key Findings

OPTION CARE ENTERPRISES, INC. is effectively a single-payer Medicaid provider with $45.6M in lifetime Medicaid revenue and no Medicare billing on file; the dataset explicitly lists "none below" for Medicare, so there is no national Medicare peer comparison available. This concentration in one payer should shape how analysts interpret volume and competitive positions (state Medicaid patterns, not national Medicare trends).

Revenue is highly concentrated in enteral nutrition and related supply codes: the precomputed top-three codes (B4035, B4161, B4160) account for 49.8% of the provider's total Medicaid revenue, indicating that roughly half of all Medicaid receipts stem from enteral feeding supplies and pediatric enteral formulas. The largest single code by revenue is B4035 ($10.5M, 239.7K claims, $44 avg paid/claim), showing a heavy operational focus on daily enteral feeding supply kits.

The provider’s operational profile matches its taxonomy (Home Infusion Therapy Pharmacy): high-volume billing for enteral feeding supplies (B4035, B4034, B4036), multiple enteral formula codes (B4161, B4160, B4149, B4154, B4152, B4153), and home infusion per-diem services (S9500). These codes and high claim counts (e.g., B4035 239.7K claims; S9500 105K claims) suggest routine, recurring supply and per-diem service delivery rather than episodic specialty procedures.

OPTION CARE holds dominant statewide positions on many core Medicaid codes, often ranking #1 in-state: B4035 ranks #1 of 31 (100th percentile; extreme outlier, far above typical state volume), B4161 ranks #1 of 16 (100th percentile; notably above typical state volume), and A4222 ranks #1 of 12 (100th percentile; extreme outlier). These top ranks and percentiles indicate the provider is a major statewide supplier for enteral supplies, pediatric enteral formulas, and infusion supply cassettes.

Several high-revenue lines show specialized pediatric focus: B4161 (pediatric hydrolyzed/amino acid formula) generated $9.1M on 14.7K claims with a $618 avg paid/claim and is the in-state leader, while B4160 (pediatric calorically dense intact nutrient formula) produced $3M and ranks #2 of 17 (94th percentile). The prominence and high average paid/claim for pediatric formulas imply a strategic emphasis on pediatric enteral nutrition to Medicaid payers.

Beyond formulas, the provider also reports substantial activity in infusion and catheter-related supplies and services: A4223 ($2.7M), A4222 ($1.5M), S9500 ($2.2M), and G0299 ($1.1M) are meaningful revenue contributors. The mix of supply codes, per-diem home infusion codes, and nursing visit codes shows a vertically integrated home-infusion service model covering supplies, device provisioning, and professional coordination.

Some code-level entries have limited or no in-state peers, which affects competitive interpretation: B4105 (in-line digestive enzyme cartridge) and B4220 (parenteral premix kit) both rank #1 of 1 with "0th percentile; no state peer volume comparison available," indicating these are niche product lines where OPTION CARE may be the sole reported Medicaid supplier in the state. Analysts should treat such single-provider rank information as evidence of monopoly-like billing for those specific items rather than broad market dominance.

The provider has been enumerated for approximately two decades (NPI enumerated 2006-07-04, ~20 years ago), which supports the interpretation that the observed large volumes and top-state rankings reflect an established, sustained operational footprint in Medicaid home infusion and enteral nutrition rather than a transient billing spike. This tenure combined with repeated #1 ranks suggests entrenched contracting and distribution relationships within the state Medicaid program.

Medicaid: Complete Services Breakdown

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

38 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
B4035	Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	239,680	$40	$10.5M
B4161	Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding…	14,730	$620	$9.1M
B4160	Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals,…	16,230	$180	$3M
B4224	Parenteral nutrition administration kit, per day	62,590	$40	$2.8M
A4223	Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)	29,170	$90	$2.7M
S9500	Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and…	104,980	$20	$2.2M
B4105	In-line cartridge containing digestive enzyme(s) for enteral feeding, each	480	$4,330	$2.1M
B4149	Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral…	6,710	$280	$1.9M
B4154	Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or…	6,770	$220	$1.5M
A4222	Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)	36,160	$40	$1.5M

Showing 1–10 of 38

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Illinois Distribution

Option Care Enterprises, Inc. — 13 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Illinois

Full comparison — all codes billed, vs. Illinois median

38 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
B4105	In-line cartridge containing digestive enzyme(s) for enteral feeding, each	1	10	480	$4,330	$2.1M
B4161	Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding…	1	20	1,330	$590	$1.8M
B4224	Parenteral nutrition administration kit, per day	1	10	35,340	$50	$1.8M
B4035	Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	1	30	2,590	$110	$1.4M
G0299	Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, each 15 minutes	13	110	3,040	$160	$1M
B4160	Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals,…	2	20	2,110	$220	$915.7K
B4149	Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral…	3	10	760	$290	$783K
A4223	Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)	1	10	2,020	$100	$625.2K
B4154	Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or…	3	20	640	$130	$556.1K
B4153	Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral…	1	10	790	$440	$431.4K

Showing 1–10 of 38

Related Providers

Other providers that share a Tax Identification Number (TIN) with Option Care Enterprises, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Trinity Homecare LLC	NY	Home Infusion Therapy Pharmacy	$0	$46.8M
Option Care Enterprises Inc	KY	Pharmacy	$0	$39.1M
Option Care Enterprises Inc	MA	Home Infusion Therapy Pharmacy	$0	$37M
Option Care Enterprises, Inc.	FL	Home Infusion Therapy Pharmacy	$0	$29.3M
Option Care Enterprises, Inc.	OH	Home Infusion Therapy Pharmacy	$0	$18.9M
Option Care Enterprises, Inc.	WA	Home Infusion Therapy Pharmacy	$0	$18.9M
Option Care Enterprises, Inc.	TX	Home Infusion Therapy Pharmacy	$0	$13.8M
Option Care Enterprises, Inc	CT	Home Infusion Therapy Pharmacy	$0	$13.3M
Option Care Home Care Inc	WI	Pharmacy	$0	$12.5M
Option Care Enterprises, Inc.	MO	Home Infusion Therapy Pharmacy	$0	$11.2M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Litholink Corporation	IL	Clinical Medical Laboratory	$2.8M	$5.5M
Laboratory Corporation Of America	IL	Clinical Medical Laboratory	$4.4M	$3.4M
Ophthalmology Surgery Center Of Illinois, LLC	IL	Ambulatory Surgical Clinic/Center	$1.7M	$0
Ashish Bhatia	IL	Procedural Dermatology Physician	$618.5K	$0
Marie Schlund	IL	Foot & Ankle Surgery Podiatrist	$189.6K	$14.9K
Paul Nelson	IL	Physical Therapist	$158.5K	$0
Joseph Daw	IL	Plastic and Reconstructive Surgery Physician	$53.9K	$0
Wendy Biela	IL	Certified Registered Nurse Anesthetist	$5.3K	$0

Option Care Enterprises, Inc. — Billing Profile & Reimbursement Data

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Option Care Enterprises, 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

Related Providers

Nearby Providers

Frequently Asked Questions

References