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

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

Ideal Option, PLLC (NPI 1457788275)

Key Findings

Field	Value
Entity Type	Organization
Organization	Ideal Option, PLLC
Address	8508 W Gage Blvd Ste A101
City	Kennewick
State	WA
ZIP	99336
Taxonomy	Clinic/Center
NPI Enumerated	October 11, 2013

Payer Source	Total Paid
Medicaid	$259.1M
Medicare	$0

IDEAL OPTION, PLLC is effectively a Medicaid-focused operation with $259.1M in reported Medicaid revenue and no Medicare billing on file; the absence of Medicare activity makes it functionally a single-payer (Medicaid) provider at scale. This concentration implies reimbursement exposure and growth opportunities are tightly coupled to Medicaid policy and contracts rather than to Medicare volumes.

Revenue concentration is highly focused: the precomputed top three Medicaid codes (99214, 80307, G0482) together account for 60.0% of this provider's total Medicaid revenue. Individually these codes are large contributors — 99214 accounts for $66.6M (26.0%), 80307 for $48.8M (19.0%), and G0482 for $38.5M (15.0%) — indicating a narrow set of service lines drive the majority of dollars.

The code mix and volumes point to a dual clinical and high-throughput lab model: large E/M volume (99214 with 693.7K claims and 99213/99215 also in the top ranks) combined with very high-volume drug testing (80307: 887.1K claims; G0482: 280.9K claims; G0481/G0480/G0483 also present). Paired with behavioral-health codes H0016 and H0001 and telehealth originating site billing Q3014, this pattern is consistent with an organization delivering substance-use disorder treatment or ambulatory behavioral health services that are tightly integrated with routine, instrumented toxicology testing.

Competitive standing in-state is dominant for multiple high-revenue codes: 80307 ranks #1 of 172 providers in Washington at the 100th percentile and is labeled an "extreme outlier," G0482 ranks #1 of 20 (100th percentile), and 99214 ranks #2 of 1823 providers (100th percentile, extreme outlier). Several other high-dollar codes are also at or near the top of state rankings (e.g., 99215 #1 of 536, 82075 #1 of 31), which together indicate IDEAL OPTION is an outsized player in the state for both E/M and definitive drug-testing services.

Some high-volume lab and related codes are flagged as statistical outliers while many smaller-volume lab codes are described as typical or unremarkable: multiple definitive drug-test codes are characterized as "extreme outlier" or "notably above typical state volume," whereas a suite of individual analyte codes (for buprenorphine, fentanyl, benzodiazepines, etc.) are ranked in the typical range for the state. This suggests the provider concentrates work into bundled or multi-analyte definitive tests at scale while also submitting routine single-analyte tests at volumes comparable to peers.

Service-line nuance: telehealth and ambulatory-somatic billing appear as meaningful adjuncts to the lab/E/M mix — Q3014 reports 356.8K claims and $8.2M revenue (ranks #1 in-state at the 100th percentile) and H0016 (medical/somatic for substance use) reports $12.4M. Together these codes indicate a model that pairs remote or site-based encounters with on-site or affiliated specimen collection and lab analysis.

Operational scale is evident in claims counts and averages: extremely large claim counts such as 887.1K for 80307 and 693.7K for 99214 are consistent with high encounter throughput and significant specimen-processing capacity, and average paid-per-claim values (for example, $96 for 99214 and $55 for 80307) show how modest per-claim reimbursement aggregates into substantial Medicaid revenue. These metrics imply both heavy utilization and reliance on volume-based reimbursement.

Tenure and market entrenchment: the NPI was enumerated 2013-10-11 (~13 years ago), indicating over a decade of billing history to build the current volumes and state-level market position. Combined with the concentration of revenue in a small set of codes and top-state rankings, the provider appears to be an established specialist in its service mix rather than a recent entrant.

Medicaid: Complete Services Breakdown

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

72 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	693,730	$100	$66.6M
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	887,120	$60	$48.8M
G0482	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	280,910	$140	$38.5M
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	229,540	$70	$14.9M
G0481	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	106,880	$130	$13.4M
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	83,250	$150	$12.7M
H0016	Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting)	97,350	$130	$12.4M
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	115,730	$100	$11.1M
82075	The lab analyst performs the technical lab test to analyze the quantitative amount of alcohol in a patient’s breath and correlates the measurement to blood alcohol content.	500,000	$20	$11M
Q3014	Telehealth originating site facility fee	356,810	$20	$8.2M

Showing 1–10 of 72

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Washington Distribution

Ideal Option, PLLC — 16 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Washington

Full comparison — all codes billed, vs. Washington median

72 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0016	Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting)	1	10	15,330	$110	$3.2M
G0482	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	1	20	1,010	$140	$3M
G0481	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	2	30	660	$100	$1.5M
80307	The lab analyst performs presumptive drug test(s) via instrumented chemistry analyzers to screen for any number of drug classes on a single date.	1	170	2,120	$40	$779.1K
G0480	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	2	90	1,760	$50	$601.4K
G0483	Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but…	1	20	1,110	$130	$509.9K
87591	The lab analyst performs a lab test for Neisseria gonorrhoeae, also called GC, using amplified nucleic acid probe technique.	12	120	2,040	$30	$464.9K
87491	The lab analyst performs a test for Chlamydia trachomatis using amplified nucleic acid probe technique.	12	120	2,020	$30	$441.1K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	2	1,820	480	$60	$379.6K
82075	The lab analyst performs the technical lab test to analyze the quantitative amount of alcohol in a patient’s breath and correlates the measurement to blood alcohol content.	1	30	820	$20	$367.8K

Showing 1–10 of 72

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ideal Option, PLLC	WA	Clinical Medical Laboratory	$0	$39.2M
Ideal Option, PLLC	MD	Addiction Medicine (Family Medicine) Physician	$0	$7.4M
Ideal Option, PLLC	MT	Addiction Medicine (Family Medicine) Physician	$0	$3.6M
Ideal Option, PLLC	MT	Addiction Medicine (Family Medicine) Physician	$0	$3.3M
Crm Physicians, LLC	OR	Internal Medicine Physician	$0	$2.1M
Ideal Option, PLLC	MT	Multi-Specialty Clinic/Center	$0	$1.2M
Ideal Option, PLLC	MT	Clinic/Center	$0	$731.9K
Ideal Option, PLLC	MT	Clinic/Center	$0	$703.9K
Ideal Option, PLLC	MT	Clinic/Center	$0	$692.7K
Ideal Option, PLLC	ND	Clinic/Center	$0	$690.9K

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Yakima Valley Farm Workers Clinic	WA	Dentist	$0	$20.5M
City Of Kennewick	WA	Ambulance	$906.2K	$11.5M
Pinnacle Pain Center, Ps	WA	Pain Medicine (Anesthesiology) Physician	$0	$11.6M
Lutheran Community Services Northwest	WA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$10.4M
Three Rivers Therapy, LLC	WA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$8.7M
Tri-cities Laboratory, LLC	WA	Clinical Medical Laboratory	$0	$8.7M
Columbia Physical Therapy Inc Ps	WA	Physical Therapist	$0	$6.7M
Ideal Balance PLLC	WA	Substance Use Disorder Rehabilitation Clinic/Center	$0	$5.3M
Qualicenters Inland Northwest L.L.C.	WA	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	$0	$5.1M
Todd Cooper, Dds, Tyson Teeples, Dmd, Md, Ryan Toponce, Dmd, Ps.	WA	Oral and Maxillofacial Surgery (Dentist)	$0	$4.8M

Ideal Option, PLLC — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References