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

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

Exceptional Opportunities, Inc (NPI 1366485047)

Field	Value
Entity Type	Organization
Organization	Exceptional Opportunities, Inc
Address	705 1st Street
City	Burt
State	IA
ZIP	50522
Taxonomy	Intellectual Disabilities Intermediate Care Facility
NPI Enumerated	June 13, 2006

Payer Source	Total Paid
Medicaid	$30.3M
Medicare	$0

Key Findings

EXCEPTIONAL OPPORTUNITIES, INC is effectively a Medicaid-focused operator with no Medicare billing on file and $30.3M in lifetime Medicaid revenue; the provider’s NPI was enumerated on 2006-06-13 (~20 years ago), indicating an established presence in its local market.

Revenue is highly concentrated: the precomputed top three Medicaid codes (S5136, H2016, H2025) account for 88.8% of the provider’s total Medicaid revenue, with S5136 generating $12.6M (41.5%), H2016 $11.7M (38.8%), and H2025 $2.6M (8.5%). This concentration suggests service- and payer-exposure risk if reimbursement or utilization for these three codes changes.

The code mix points to an intellectual-disabilities / community-support operating model: S5136 (Companion care, adult; per diem) and H2016 (Comprehensive community support services; per diem) together drive the majority of revenue, implying day-to-day companion and community support services are central to operations rather than medically oriented Medicare services. H2025 (ongoing support to maintain employment, per 15 minutes) and T2021 (day habilitation, waiver; per 15 minutes) further indicate a meaningful focus on employment supports and habilitation services.

Volume and payment details reinforce a high-utilization, per-diem service profile: S5136 shows 18.6K claims at a $676 avg paid/claim totaling $12.6M, while H2016 records 9.4K claims at a $1256 avg paid/claim totaling $11.7M. The presence of high claim counts with per-diem codes underscores operational scale in routine support services rather than episodic medical care.

Competitive standing across these Medicaid codes is generally modest-to-strong but not dominant statewide: S5136 ranks #28 of 82 (67th percentile; typical, unremarkable volume for this code) and H2016 ranks #94 of 176 (47th percentile; typical, unremarkable volume for this code), indicating typical activity levels relative to peers. By contrast, H2025 ranks #17 of 65 (75th percentile; typical, unremarkable volume for this code) and T2021 ranks #12 of 103 (89th percentile; typical, unremarkable volume for this code), showing relatively stronger position in employment supports and day habilitation.

No codes are flagged as statistical outliers in the provided labels; each top code is described as "typical, unremarkable volume for this code," which suggests the provider’s utilization patterns sit within expected state-level ranges rather than reflecting extreme deviations. This reduces immediate concern about anomalous billing but keeps attention on the high revenue concentration.

From a payer-mix perspective the practice is single-payer in effect: with no Medicare revenue and $30.3M in Medicaid receipts, strategic exposure is concentrated to Medicaid policy, rate-setting, and waiver program changes that affect per-diem and per-15-minute community support codes. Analysts should treat shifts in Medicaid program design or rates for S5136, H2016, and H2025 as material to the organization’s revenue outlook.

Operationally, the reliance on per-diem companion care and comprehensive community supports combined with notable activity in employment supports and day habilitation suggests a service portfolio aimed at long-term community living and vocational maintenance for individuals with intellectual disabilities. Given the provider’s ~20-year tenure and concentrated Medicaid revenue base, monitoring state policy changes to companion care and community support reimbursement will be essential for forecasting revenue stability.

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
S5136	Companion care, adult (e.g., iadl/adl); per diem	18,600	$680	$12.6M
H2016	Comprehensive community support services, per diem	9,350	$1,260	$11.7M
H2025	Ongoing support to maintain employment, per 15 minutes	5,770	$440	$2.6M
T2021	Day habilitation, waiver; per 15 minutes	15,800	$160	$2.5M
H2015	Comprehensive community support services, per 15 minutes	5,950	$150	$881.2K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Iowa Distribution

Exceptional Opportunities, Inc — 0 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Iowa

Full comparison — all codes billed, vs. Iowa median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5136	Companion care, adult (e.g., iadl/adl); per diem	28	80	9,410	$490	$17.9M
H2016	Comprehensive community support services, per diem	94	180	10,790	$390	$15.2M
H2025	Ongoing support to maintain employment, per 15 minutes	17	70	2,970	$300	$1.9M
H2015	Comprehensive community support services, per 15 minutes	43	100	4,130	$160	$1.9M
T2021	Day habilitation, waiver; per 15 minutes	12	100	2,780	$60	$386.9K

Exceptional Opportunities, Inc — Billing Profile & Reimbursement Data

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Exceptional Opportunities, 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

Frequently Asked Questions

References