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

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

Commonwealth Of Massachusetts (NPI 1386773273)

Field	Value
Entity Type	Organization
Organization	Commonwealth Of Massachusetts
Address	35 Nagog Park
City	Acton
State	MA
ZIP	01720
Taxonomy	Case Management Agency
NPI Enumerated	March 5, 2007

Payer Source	Total Paid
Medicaid	$334.3M
Medicare	$0

Key Findings

This provider is effectively single‑payer: there is no Medicare billing on file and all reported lifetime federal revenue is Medicaid‑based, totaling $334.3M. The NPI was enumerated on 2007-03-05 (~19 years ago), indicating an established presence in the state Medicaid market rather than a recent entrant.

Revenue is highly concentrated: the top 3 Medicaid codes account for 95.8% of this provider's total Medicaid revenue, with T2016 alone representing $289.8M (86.7% of Medicaid revenue). That concentration points to a business model driven overwhelmingly by a single service line rather than a diversified payer or service mix.

The code mix signals an operation centered on residential habilitation and community support: T2016 (Habilitation, residential, waiver; per diem) is the dominant revenue driver, while S5100 (Day care services, adult; per 15 minutes) and T2023 (Targeted case management; per month) provide complementary day‑service and case management functions. These service categories align with the provider taxonomy of Case Management Agency and suggest integrated residential plus community/day support offerings.

T2016’s position in the state market is modest: it ranks #11 of 25 providers in-state (58th percentile; typical, unremarkable volume for this code). Despite generating the bulk of this entity’s Medicaid dollars, the provider is not an outlier or dominant statewide leader for residential habilitation volume according to the supplied rank and percentile.

S5100 (Day care services, adult) is a notable strength relative to peers: 71.7K claims produced $19.4M (5.8% of Medicaid revenue) and this provider ranks #13 of 189 providers in-state (94th percentile; notably above typical state volume). That percentile indicates a comparatively strong foothold in adult day care services even though S5100 is a smaller share of total dollars than T2016.

T2023 (Targeted case management; per month) contributes $11M (3.3% of Medicaid revenue) and ranks #17 of 70 providers in-state (77th percentile; typical, unremarkable volume). The presence of recurring monthly case management payments reinforces the agency’s role in care coordination and long‑term service management alongside its residential and day programs.

Smaller Medicaid codes collectively show breadth but limited revenue impact: H2015 $4.5M (1.3%, rank #61 of 147, 59th percentile), T2021 $4.1M (1.2%, rank #14 of 24, 43th percentile), T2019 $2.3M (0.7%, rank #15 of 24, 39th percentile), H2023 $1.7M (0.5%, rank #19 of 23, 18th percentile), and T2003 $1.5M (0.5%, rank #101 of 245, 59th percentile). These smaller streams reflect typical participation across community support, day habilitation, supported employment, and transportation without materially diversifying revenue away from the dominant habilitation per‑diem line.

Payment characteristics underline the operational model: T2016’s average paid/claim of $8200 indicates high‑value per‑diem residential services drive the financial base, while S5100’s $270 avg paid/claim (per 15 minutes) and T2023’s $339 avg paid/claim (per month) point to a combination of high‑value residential care plus higher‑volume, time‑based day and case management services. That mix creates a revenue profile reliant on a few high‑value claims plus large unit counts in time‑based services, concentrating both revenue and operational focus in Medicaid.

Medicaid: Complete Services Breakdown

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

8 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	35,340	$8,200	$289.8M
S5100	Day care services, adult; per 15 minutes	71,680	$270	$19.4M
T2023	Targeted case management; per month	32,460	$340	$11M
H2015	Comprehensive community support services, per 15 minutes	18,120	$250	$4.5M
T2021	Day habilitation, waiver; per 15 minutes	19,630	$210	$4.1M
T2019	Habilitation, supported employment, waiver; per 15 minutes	22,570	$100	$2.3M
H2023	Supported employment, per 15 minutes	15,140	$120	$1.7M
T2003	Non-emergency transportation; encounter/trip	57,870	$30	$1.5M

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Commonwealth Of Massachusetts — 0 of 8 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

8 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	11	30	29,930	$10,070	$358.9M
T2023	Targeted case management; per month	17	70	8,210	$510	$8.6M
H2023	Supported employment, per 15 minutes	19	20	28,450	$190	$5.6M
H2015	Comprehensive community support services, per 15 minutes	61	150	7,770	$140	$4.8M
T2021	Day habilitation, waiver; per 15 minutes	14	20	20,590	$210	$4.5M
S5100	Day care services, adult; per 15 minutes	13	190	2,000	$230	$3.1M
T2019	Habilitation, supported employment, waiver; per 15 minutes	15	20	24,690	$120	$3.1M
T2003	Non-emergency transportation; encounter/trip	101	250	40,490	$30	$2.2M

Nearby Providers

Other providers in the same ZIP code as Commonwealth Of Massachusetts, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Insulet Corporation	MA	Durable Medical Equipment & Medical Supplies	$0	$15.2M
Town Of Acton	MA	Land Ambulance	$285.9K	$391.5K
Middlesex Endoscopy Center LLC	MA	Endoscopy Clinic/Center	$605.9K	$57.3K
Cvs Pharmacy Inc	MA	Pharmacy	$260.6K	$0
Acton Pharmacy Inc	MA	Community/Retail Pharmacy	$183.8K	$0
Ann Joyce	MA	Gastroenterology Physician	$62.4K	$0
John Fava	MA	Physical Therapist	$21.5K	$0

Commonwealth Of Massachusetts — Billing Profile & Reimbursement Data

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Commonwealth Of Massachusetts — 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