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

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

Above Expectations LLC (NPI 1477170165)

Field	Value
Entity Type	Organization
Organization	Above Expectations LLC
Address	1714 Nine Foot Rd
City	Greenwood
State	DE
ZIP	19950
Taxonomy	Intellectual & Developmental Disabilities Psychologist
NPI Enumerated	June 29, 2020

Payer Source	Total Paid
Medicaid	$13M
Medicare	$0

Key Findings

ABOVE EXPECTATIONS LLC is registered as an Intellectual & Developmental Disabilities Psychologist in Greenwood, DE and has an NPI enumeration date of 2020-06-29 (~6 years ago), indicating several years of active billing history in state Medicaid programs. The provider’s public records show no Medicare billing on file, which frames its operational footprint largely within state-managed Medicaid services.

This provider is effectively a single-payer Medicaid operator: lifetime Medicare revenue is none and total Medicaid revenue is $13M, so all reported programmatic scale and risk are concentrated in Medicaid funding and policy. Analysts should view any market comparisons or trend analysis through a Medicaid-only lens.

Revenue concentration is extreme within the provider’s Medicaid portfolio: the precomputed top 3 Medicaid codes account for 100.0% of this provider’s total Medicaid revenue, with two codes explicitly listed capturing the full reported revenue base. Such concentration indicates that a very small set of service lines drives the business’s financial outcomes.

The top revenue-driving code, T2025 (Waiver services; not otherwise specified (nos)), accounts for $11.7M in revenue from 11K claims at an average paid per claim of $1063. T2025 represents 90.1% of this provider’s total Medicaid revenue and the provider ranks #7 of 10 in-state (33rd percentile) for this code; this ranking is described as typical, unremarkable volume rather than a market-leading position.

The second principal code, T2016 (Habilitation, residential, waiver; per diem), generated $1.3M from 956 claims with an average paid per claim of $1337 and represents 9.9% of the provider’s Medicaid revenue. The provider ranks #9 of 9 in-state for T2016 (0th percentile), and this volume is also characterized as typical/unremarkable, suggesting limited scale in per-diem residential habilitation compared with other in-state providers.

Code mix and descriptions (waiver services and residential habilitation) imply the provider operates primarily inside Medicaid waiver programs delivering residential and habilitative supports for individuals with intellectual and developmental disabilities, rather than generating revenue from mainstream Medicare-covered clinical services. The absence of Medicare billing reinforces that the organization’s service model is oriented to state waiver reimbursement mechanisms.

Competitive standing in-state is modest: ranking mid-to-low for the two primary waiver codes (#7/10 and #9/9) indicates the provider is not a dominant statewide player for these service lines. Given that 100.0% of Medicaid revenue is concentrated in these waiver-related codes, the provider’s financial performance and competitive position are highly sensitive to changes in state waiver policies, reimbursement rates, or contract opportunities.

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
T2025	Waiver services; not otherwise specified (nos)	11,000	$1,060	$11.7M
T2016	Habilitation, residential, waiver; per diem	960	$1,340	$1.3M

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Delaware Distribution

Above Expectations LLC — 0 of 2 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Delaware

Full comparison — all codes billed, vs. Delaware median

2 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2025	Waiver services; not otherwise specified (nos)	7	10	37,650	$670	$43M
T2016	Habilitation, residential, waiver; per diem	9	10	23,150	$620	$21.9M

Above Expectations LLC — Billing Profile & Reimbursement Data

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Above Expectations LLC — Billing Profile & Reimbursement Data

Sign up for Above Expectations LLC — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Frequently Asked Questions

References