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

Why is the Medicaid comparison limited to South Dakota 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. South Dakota (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.

South Dakota Achieve (NPI 1376675785)

Field	Value
Entity Type	Organization
Organization	South Dakota Achieve
Address	4100 S Western Ave
City	Sioux Falls
State	SD
ZIP	57105
Taxonomy	Developmental Disabilities Clinic/Center
NPI Enumerated	March 12, 2007

Payer Source	Total Paid
Medicaid	$166.9M
Medicare	$0

Key Findings

SOUTH DAKOTA ACHIEVE is effectively a Medicaid-focused developmental-disabilities provider: it has no Medicare billing on file and reports $166.9M in lifetime Medicaid revenue, indicating operations are overwhelmingly tied to state waiver and habilitation programs rather than fee-for-service Medicare lines. The NPI was enumerated on 2007-03-12 (about 19 years ago), consistent with an established presence in the state disability services market.

Revenue is highly concentrated in a small set of waiver and habilitation codes: the top 3 Medicaid codes by revenue account for 93.1% of the provider's total Medicaid revenue, showing dependence on a few high-volume service lines rather than a broad mix of smaller claims. This concentration implies that changes to reimbursement or program rules for those specific codes could materially impact the provider’s financial performance.

T2016 is the dominant revenue driver: T2016 (Habilitation, residential, waiver; per diem) accounts for $113.4M or 67.9% of Medicaid revenue and represents the largest single source of funds. The scale and per-diem nature of T2016 revenue suggest the organization operates sizable residential habilitation programs serving long-stay or high-intensity waiver participants.

T2020 and S0281 provide most of the remainder of concentrated revenue: T2020 (Day habilitation, waiver; per diem) contributes $31.3M (18.8%) and S0281 (Medical home program, comprehensive care coordination and planning, maintenance of plan) contributes $10.7M (6.4%), together with T2016 forming the 93.1% top-three share. This mix indicates a business model combining residential habilitation, day habilitation services, and centralized care coordination, with revenue drivers tied to both per-diem service delivery and care management programs.

Competitive standing in-state is strong for multiple codes: the provider ranks #2 of 21 (95th percentile) for T2016 and #2 of 20 (95th percentile) for T2020, signaling it is one of the largest providers of both residential and day habilitation in South Dakota. It ranks #1 of 21 (100th percentile) for S0281, indicating statewide leadership in billing for medical home/comprehensive care coordination services. These rankings portray the organization as a major, often market-leading participant in the state's waiver services ecosystem.

Several codes are labeled extreme outliers or unusually high-volume relative to state norms: T2028, T2014, and T2018 each rank at the 100th percentile with notes of being "extreme outlier" or "far above typical state volume," which suggests this provider supplies specialized items or program types at volumes not seen at most peers. These outlier patterns may reflect unique service offerings, large client rosters in specific program categories, or operational scale in niche waiver services.

While the provider shows breadth across multiple waiver-related codes, several ancillary habilitation codes (e.g., T2025, T2017, T2019) contribute much smaller shares of revenue, indicating a focused service portfolio centered on residential/day habilitation and care coordination rather than a wide array of minor procedure billing. This concentrated footprint should inform competitive and contracting discussions where payers seek to manage utilization in those key program areas.

Given the absence of Medicare billing, payer mix is effectively single-payer at the Medicaid level; analysts should treat Medicaid policy, state waiver design, and South Dakota reimbursement changes as the primary levers that will influence this provider’s future volumes and revenue. Monitoring state-level rate setting and any reclassification of the top codes (T2016, T2020, S0281) will be more material here than federal Medicare trends.

Medicaid: Complete Services Breakdown

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

9 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	122,330	$930	$113.4M
T2020	Day habilitation, waiver; per diem	105,130	$300	$31.3M
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	25,760	$420	$10.7M
T2025	Waiver services; not otherwise specified (nos)	56,750	$130	$7.3M
T2017	Habilitation, residential, waiver; 15 minutes	8,410	$160	$1.3M
T2028	Specialized supply, not otherwise specified, waiver	26,790	$50	$1.3M
T2014	Habilitation, prevocational, waiver; per diem	24,320	$40	$1.1M
T2018	Habilitation, supported employment, waiver; per diem	47,180	$10	$377.4K
T2019	Habilitation, supported employment, waiver; per 15 minutes	2,340	$50	$105.3K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Dakota Distribution

South Dakota Achieve — 5 of 9 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Dakota

Full comparison — all codes billed, vs. South Dakota median

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	2	20	6,880	$1,660	$31.6M
T2020	Day habilitation, waiver; per diem	2	20	7,340	$500	$8.9M
S0281	Medical home program, comprehensive care coordination and planning, maintenance of plan	1	20	6,090	$420	$3M
T2025	Waiver services; not otherwise specified (nos)	2	20	5,410	$180	$1.9M
T2017	Habilitation, residential, waiver; 15 minutes	1	10	470	$270	$437.9K
T2018	Habilitation, supported employment, waiver; per diem	1	20	1,510	$80	$433.9K
T2014	Habilitation, prevocational, waiver; per diem	1	20	1,210	$130	$410.3K
T2019	Habilitation, supported employment, waiver; per 15 minutes	2	20	480	$90	$288.6K
T2028	Specialized supply, not otherwise specified, waiver	1	30	910	$50	$169.8K

Nearby Providers

Other providers in the same ZIP code as South Dakota Achieve, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Dakotabilities	SD	Voluntary or Charitable Agency	$0	$77.8M
Sanford Medical Center	SD	Family Medicine Physician	$0	$68.8M
Volunteers Of America, Dakotas	SD	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$60.9M
Southeastern Behavioral Healthcare	SD	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$59.1M
Resouces For Human Development, Inc.	SD	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$31.1M
Sanford Medical Center	SD	General Acute Care Hospital	$0	$24.4M
Childrens Dental Center	SD	Pediatric Dentistry	$0	$24M
Sanford Medical Center	SD	Air Ambulance	$0	$11.9M
Avera Mckennan	SD	Family Medicine Physician	$0	$10.6M
Sanford Clinic	SD	Pediatrics Physician	$0	$5.5M

South Dakota Achieve — Billing Profile & Reimbursement Data

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South Dakota Achieve — 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