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

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

Region Iv Family Outreach, Inc (NPI 1447300132)

Field	Value
Entity Type	Organization
Organization	Region Iv Family Outreach, Inc
Address	1236 Helena Ave
City	Helena
State	MT
ZIP	59601
Taxonomy	Case Manager/Care Coordinator
NPI Enumerated	January 12, 2007

Payer Source	Total Paid
Medicaid	$7.3M
Medicare	$0

Key Findings

Region IV Family Outreach, Inc (Case Manager/Care Coordinator) is a long-tenured Medicaid-focused provider based in Helena, MT — its NPI was enumerated on 2007-01-12 (~19 years ago). The organization’s public billing footprint shows no Medicare billing on file and an exclusively Medicaid-funded revenue base, which frames its operating and reimbursement exposure largely around state Medicaid policies and waiver programs.

This provider reports $7.3M in lifetime Medicaid revenue and no Medicare revenue (none); the absence of Medicare billing makes it effectively a single-payer Medicaid operation for the claims data on file. Operational and financial planning should therefore prioritize Medicaid program changes, rate-setting, and waiver administration rather than Medicare reimbursement dynamics.

Revenue is highly concentrated in a small set of waiver and community-support codes: the top three Medicaid codes (T2013, S5135, T2032) together account for 79.3% of the provider’s total Medicaid revenue. Those three codes are T2013: $2.5M revenue (34.5% of total), S5135: $1.9M revenue (26.0% of total), and T2032: $1.4M revenue (18.8% of total) — any shifts to reimbursement or eligibility for these specific services would materially affect overall revenue.

The code mix indicates a service model focused on community habilitation, in-home companion/ADL support, and residential waiver care: T2013 (habilitation, educational, waiver; per hour), S5135 (companion care, adult; per 15 minutes), and T2032 (residential care, waiver; per month) are the primary revenue drivers. The presence of H2025 (ongoing support to maintain employment, per 15 minutes) with $1.3M revenue (17.8% of total) further underscores a portfolio built around long-term supportive services and waiver-funded community integration programs.

State-level competitive standings for the top codes show the provider as a steady but not dominant in-state participant: T2013 ranks #6 of 17 (69th percentile; typical, unremarkable volume for this code), S5135 ranks #3 of 6 (60th percentile; typical, unremarkable volume for this code), and T2032 ranks #6 of 20 (74th percentile; typical, unremarkable volume for this code). Those placements indicate higher-than-median activity in some segments but stop short of labeling the organization a market leader statewide.

Beyond the top three, the provider also bills notable secondary services: H2025 at $1.3M (17.8% of total, ranks #3 of 15, 86th percentile; described as typical, unremarkable volume for this code) and T2003 non-emergency transportation at $149.2K (2.1% of total, ranks #22 of 39, 45th percentile). A small number of claim lines report $0 average paid (e.g., G9002, 97153, 97155) and should be reviewed for billing context, but they represent negligible revenue impact relative to the concentrated waiver services.

Concentration in a few waiver-related service lines presents both operational risk and focused opportunity: because 79.3% of revenue is tied to T2013, S5135, and T2032, the provider is sensitive to Montana Medicaid waiver policy, rate changes, and provider enrollment rules. Conversely, that concentration also signals domain expertise in community habilitation and residential waiver services — potential areas for capacity expansion, partnership, or competitive differentiation within the Medicaid-managed-care and waiver ecosystem.

Medicaid: Complete Services Breakdown

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

11 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2013	Habilitation, educational, waiver; per hour	1,150	$2,180	$2.5M
S5135	Companion care, adult (e.g., iadl/adl); per 15 minutes	2,420	$780	$1.9M
T2032	Residential care, not otherwise specified (nos), waiver; per month	1,710	$800	$1.4M
H2025	Ongoing support to maintain employment, per 15 minutes	1,550	$830	$1.3M
T2003	Non-emergency transportation; encounter/trip	1,960	$80	$149.2K
T2028	Specialized supply, not otherwise specified, waiver	620	$50	$30.9K
T2002	Non-emergency transportation; per diem	200	$140	$26.7K
T1027	Family training and counseling for child development, per 15 minutes	40	$100	$3.4K
G9002	Coordinated care fee, maintenance rate	120	$0	$0
97153	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	50	$0	$0

Showing 1–10 of 11

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Montana Distribution

Region Iv Family Outreach, Inc — 0 of 8 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Montana

Full comparison — all codes billed, vs. Montana median

11 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2013	Habilitation, educational, waiver; per hour	6	20	770	$2,020	$5.2M
S5135	Companion care, adult (e.g., iadl/adl); per 15 minutes	3	10	1,900	$450	$1.4M
T2032	Residential care, not otherwise specified (nos), waiver; per month	6	20	1,120	$830	$1M
H2025	Ongoing support to maintain employment, per 15 minutes	3	20	940	$590	$609.8K
97153	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	7	10	1,730	$100	$225.6K
T2002	Non-emergency transportation; per diem	28	30	1,440	$110	$141.5K
T2003	Non-emergency transportation; encounter/trip	22	40	2,180	$30	$78K
T2028	Specialized supply, not otherwise specified, waiver	17	40	570	$40	$58.4K
T1027	Family training and counseling for child development, per 15 minutes	3	10	80	$90	$30.2K
97155	The provider, a physician or other qualified healthcare professional, administers adaptive behavior treatment face–to–face with one patient and makes modifications in the protocol targets and…	7	10	470	$50	$22.6K

Showing 1–10 of 11

Nearby Providers

Other providers in the same ZIP code as Region Iv Family Outreach, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
West Mont	MT	Adult Care Home Facility	$0	$34.7M
Intermountain Deaconess Home	MT	Emotionally Disturbed Childrens' Residential Treatment Facility	$0	$11.9M
County Of Lewis & Clark Lewis & Clark County School District #1	MT	Local Education Agency (LEA)	$0	$10.8M
Pediatric Dentistry PC	MT	Pediatric Dentistry	$0	$9.9M
Montana Children's Home & Hospital	MT	General Acute Care Hospital	$0	$8.7M
Lewis And Clark Emergency Physicians P C	MT	Emergency Medicine Physician	$0	$6.6M
Montana Independent Living Project	MT	In Home Supportive Care Agency	$0	$6M
St. Peter's Health	MT	Family Medicine Physician	$0	$5.2M
Edgewood Helena Senior Living LLC	MT	Assisted Living Facility	$0	$4.7M
Montana Surgery Center	MT	Ambulatory Surgical Clinic/Center	$0	$4.6M

Region Iv Family Outreach, Inc — Billing Profile & Reimbursement Data

Sign up for Region Iv Family Outreach, Inc — Billing Profile & Reimbursement Data policy alerts

Region Iv Family Outreach, Inc — Billing Profile & Reimbursement Data

Sign up for Region Iv Family Outreach, Inc — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References