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

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

Capital Care, Inc (NPI 1366527111)

Field	Value
Entity Type	Organization
Organization	Capital Care, Inc
Address	2401 Blueridge Ave
City	Silver Spring
State	MD
ZIP	20902
Taxonomy	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
NPI Enumerated	October 26, 2006

Payer Source	Total Paid
Medicaid	$101.9M
Medicare	$0

Key Findings

CAPITAL CARE, INC is effectively a single‑payer Medicaid provider: there is no Medicare billing on file and the provider reports $101.9M in lifetime Medicaid revenue. This concentration means analyses of this entity should focus on Medicaid policy, reimbursement rates, and waiver program changes rather than Medicare trends.

Revenue is highly concentrated in a very small set of service lines: the precomputed top three Medicaid codes account for 94.5% of total Medicaid revenue. Those top three codes are T2016 ($75.7M; 128.1K claims; $591 avg paid/claim, 74.3% of Medicaid revenue), H0025 ($10.4M; 28.7K claims; $364 avg paid/claim, 10.2% of Medicaid revenue), and S5135 ($10.1M; 65.6K claims; $154 avg paid/claim, 9.9% of Medicaid revenue).

The code mix and service descriptors indicate a core business built around residential habilitation and daily support services: T2016 is a per‑diem habilitation residential waiver code and represents the majority of revenue, while S5135 (companion care, per 15 minutes) and T2021 (day habilitation, per 15 minutes) reflect extensive in‑day and in‑home support activity. H0025 (behavioral health prevention education) further signals structured behavioral/educational interventions alongside residential supports. This pattern is consistent with an Intellectual and/or Developmental Disabilities community‑based residential treatment facility delivering both residential and community habilitation.

Competitive standing within the state is strong for the provider’s primary service lines: CAPITAL CARE ranks #1 of 11 providers in‑state for T2016 and is at the 100th percentile (described as notably above typical state volume), and it also ranks #1 of 12 providers for S5135 (100th percentile; notably above typical state volume). For H0025 the provider ranks #2 of 10 and sits at the 89th percentile, indicating a high but not exclusive share of prevention/education behavioral services in‑state.

Claims volumes and payment intensity demonstrate operational scale: T2016 appears as a large inpatient/residential revenue stream with 128.1K claims at $591 average paid per claim, while S5135 shows 65.6K claims at $154 avg and H0025 shows 28.7K claims at $364 avg. These high claim counts and per‑unit payments are indicative of sustained census levels (for per‑diem billing) and frequent, recurring short‑interval services (for per‑15‑minute codes).

The provider shows service breadth within the disability habilitation continuum: lower‑revenue but still relevant codes include T2021 (25.7K claims; $155 avg; $4M revenue, 3.9% of Medicaid revenue; ranks #3 of 8 providers) and T2015 (15.8K claims; $99 avg; $1.6M revenue, 1.5% of Medicaid revenue; ranks #1 of 3 providers). These codes suggest supplementary day habilitation and prevocational programming that complement the dominant residential habilitation activity.

Long tenure in the market: the NPI was enumerated on 2006-10-26 (~20 years ago), indicating an established presence and likely enduring relationships with state Medicaid and waiver administrators. This longevity may support contract stability and institutional knowledge relevant to payers negotiating rates or program changes.

The concentration risk for payers is material: with Medicaid representing all reported revenue and the top three codes comprising 94.5% of Medicaid revenue, any changes to reimbursement policy, waiver eligibility, or utilization management for T2016, H0025, or S5135 would be expected to materially affect the provider’s revenue and regional service capacity. Payers should prioritize monitoring those specific codes when assessing financial or network impacts.

Medicaid: Complete Services Breakdown

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

7 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	128,140	$590	$75.7M
H0025	Behavioral health prevention education service (delivery of services with target population to affect knowledge, attitude and/or behavior)	28,680	$360	$10.4M
S5135	Companion care, adult (e.g., iadl/adl); per 15 minutes	65,630	$150	$10.1M
T2021	Day habilitation, waiver; per 15 minutes	25,730	$160	$4M
T2015	Habilitation, prevocational, waiver; per hour	15,820	$100	$1.6M
S9977	Meals, per diem, not otherwise specified	5,700	$10	$39.9K
S5170	Home delivered meals, including preparation; per meal	2,100	$10	$10.5K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maryland Distribution

Capital Care, Inc — 3 of 7 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maryland

Full comparison — all codes billed, vs. Maryland median

7 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	1	10	33,370	$580	$25.8M
H0025	Behavioral health prevention education service (delivery of services with target population to affect knowledge, attitude and/or behavior)	2	10	5,340	$360	$4.3M
T2021	Day habilitation, waiver; per 15 minutes	3	10	17,100	$160	$3.7M
S5135	Companion care, adult (e.g., iadl/adl); per 15 minutes	1	10	11,460	$190	$2.9M
T2015	Habilitation, prevocational, waiver; per hour	1	10	11,390	$90	$989.4K
S9977	Meals, per diem, not otherwise specified	2	10	7,450	$10	$53.5K
S5170	Home delivered meals, including preparation; per meal	1	10	2,100	$1	$9.7K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Cornerstone Montgomery, Inc.	MD	Community/Behavioral Health Agency	$0	$29.5M
Kidz & Family Dental Center	MD	Dental Clinic/Center	$0	$13.3M
Smile Care 4 Children, LLC	MD	Pediatric Dentistry	$0	$10.5M
C Arefi B Nasehi & Associates PC	MD	General Practice Dentistry	$0	$7M
Pediatric Associates	MD	Primary Care Clinic/Center	$0	$6.8M
Right Care Pediatrics Inc	MD	Pediatrics Physician	$0	$5.3M
Derm Associates LLC	MD	Dermatology Physician	$5.1M	$11K
Virant Diagnostics, Inc	MD	Clinical Medical Laboratory	$48.8K	$4.3M
Frederick Min	MD	Hematology & Oncology Physician	$3.2M	$0
Alan Matsumoto	MD	Rheumatology Physician	$2.2M	$0

Capital Care, Inc — Billing Profile & Reimbursement Data

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Capital Care, 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