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

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

Apex Caring Services, LLC (NPI 1427574433)

Field	Value
Entity Type	Organization
Organization	Apex Caring Services, LLC
Address	13784 St Paul St
City	Thornton
State	CO
ZIP	80602
Taxonomy	In Home Supportive Care Agency
NPI Enumerated	August 21, 2017

Payer Source	Total Paid
Medicaid	$33.5M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and $33.5M in lifetime Medicaid revenue, indicating it operates effectively as a Medicaid-focused billing entity rather than a dual-payer practice. The absence of Medicare activity combined with material Medicaid volume makes Medicaid policy and rate changes the primary commercial risk driver for this organization.

Revenue is highly concentrated: the precomputed top-3 Medicaid codes account for 100.0% of this provider's total Medicaid revenue, with H0038 alone representing 87.7% ($29.4M) and T1019 representing 12.3% ($4.1M). This concentration implies the business’s financial performance is heavily dependent on a very small set of service lines.

The code mix (H0038 — Self-help/peer services, per 15 minutes; T1019 — Personal care services, per 15 minutes) points to an in-home supportive care operation focused on time-based, direct-service delivery: primarily peer-support behavioral health services and hands-on personal care delivered in short time units. That combination aligns with a community-based support model rather than episodic medical or durable equipment services.

H0038 activity is large in absolute dollars and volume (75.5K claims, $389 avg paid/claim) and this provider ranks #14 of 276 in-state (95th percentile), which places it among the larger statewide billers for that code; the data label for this code is "typical, unremarkable volume for this code," indicating the high ranking sits within the expected distribution rather than being flagged as an extreme outlier. The high rank combined with the label suggests the provider is a notable but not anomalous regional player in peer/self-help services.

T1019 activity (31.1K claims, $133 avg paid/claim) accounts for $4.1M and ranks #81 of 475 in-state (83th percentile; typical, unremarkable volume for this code), denoting a solid but not dominant presence in personal care services. This ranking profile signals a meaningful operational footprint in personal care without the same statewide prominence it holds for H0038.

Average paid per claim differs substantially between the two major codes ($389 for H0038 vs $133 for T1019), which likely reflects differences in rate schedules, billing units, or allowable structures for peer-support versus personal care time units. Analysts should treat per-claim payment levels and claim-volume dynamics together when modeling revenue sensitivity to utilization shifts.

The National Provider Identifier was enumerated on 2017-08-21 (~9 years ago), indicating the organization has several years of Medicaid billing history to establish operational patterns and trend analysis. This tenure supports analysis of longitudinal shifts in code mix and utilization within Medicaid.

Given that nearly all Medicaid revenue is concentrated in a very small set of time-based community support codes, the provider is operationally exposed to any state-level reimbursement, eligibility, or prior authorization changes affecting H0038 and T1019. For payer/provider analysts, monitoring policy changes for peer-support and personal care services and benchmarking claim-volume trends against the statewide ranks shown here 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.

2 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0038	Self‑help/peer services, per 15 minutes	75,500	$390	$29.4M
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	31,070	$130	$4.1M

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Colorado Distribution

Apex Caring Services, LLC — 1 of 2 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Colorado

Full comparison — all codes billed, vs. Colorado median

2 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0038	Self‑help/peer services, per 15 minutes	14	280	2,330	$210	$4.8M
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	81	480	5,200	$150	$3.5M

Nearby Providers

Other providers in the same ZIP code as Apex Caring Services, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Simple. Optimized. Solutions. Inc.	CO	Home Health Agency	$0	$8.2M
Kelsey Coffran	CO	Family Nurse Practitioner	$64.8K	$0
Lorraine Malonson	CO	Physician Assistant	$22.2K	$0

Apex Caring Services, LLC — Billing Profile & Reimbursement Data

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Apex Caring Services, LLC — 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