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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

Ability First, LLC (NPI 1477685139)

Field	Value
Entity Type	Organization
Organization	Ability First, LLC
Address	1113 Rhode Island St Ne
City	Albuquerque
State	NM
ZIP	87110
Taxonomy	Exclusive Provider Organization
NPI Enumerated	March 9, 2007

Payer Source	Total Paid
Medicaid	$49M
Medicare	$0

Key Findings

ABILITY FIRST, LLC reports no Medicare billing on file and $49M in lifetime Medicaid revenue, making it effectively a single-payer (Medicaid) operation at scale in this dataset. Its taxonomy is Exclusive Provider Organization and the NPI was enumerated 2007-03-09 (~19 years ago), indicating a long-tenured Medicaid participant based in ALBUQUERQUE, NM.

Revenue is highly concentrated: the precomputed top three Medicaid codes account for 97.7% of this provider's total Medicaid revenue, demonstrating extreme reliance on a very small set of service lines rather than a broad mix of Medicaid billings. This concentration suggests financial sensitivity to changes in reimbursement or utilization for those specific waiver and community-based codes.

The dominant revenue driver is T2016 (Habilitation, residential, waiver; per diem): 84.2K claims, $316 avg paid/claim, $26.6M revenue (54.3% of this provider's total Medicaid revenue). This indicates the provider operates large-volume residential habilitation/waiver programs where per‑diem funding represents the majority of its Medicaid receipts.

The second major code is T2033 (Residential care, not otherwise specified (nos), waiver; per diem): 83.2K claims, $177 avg paid/claim, $14.7M revenue (30.0% of this provider's total Medicaid revenue). Together with T2016, the two per‑diem residential waiver codes drive the bulk of operations, signaling a business model centered on residential waiver services rather than outpatient medical care.

H2021 (Community-based wrap-around services, per 15 minutes) is the third top code with 33.1K claims, $197 avg paid/claim, $6.5M revenue (13.3% of this provider's total Medicaid revenue). The presence of a sizable H2021 line indicates the provider also delivers significant community-based, short-interval support services in addition to residential care.

Competitive standing by in-state rank is solid but not dominant for the top codes: T2016 ranks #11 of 40 providers (74th percentile; typical, unremarkable volume for this code), T2033 ranks #7 of 39 (84th percentile; typical, unremarkable volume for this code), and H2021 ranks #7 of 62 (90th percentile; typical, unremarkable volume for this code). These ranks and the underlying labels indicate ABILITY FIRST is a meaningful statewide participant in residential and community waiver services but not an extreme outlier.

Smaller Medicaid codes together contribute only a marginal portion of revenue: T2021 (Day habilitation, waiver; per 15 minutes) reported 9K claims and $789.7K revenue, T1002 (Rn services, up to 15 minutes) reported 1.2K claims and $147K revenue, T2025 reported $143.2K, and T1005 reported $38.8K. The presence of these lower-dollar, lower-volume service lines suggests some programmatic breadth around day habilitation and nursing/respite services, but they are not material to the provider's overall Medicaid revenue base.

The service mix (per-diem residential codes plus per-15-minute community supports) and the high share of revenue coming from waiver-oriented codes imply the organization operates primarily as a residential habilitation and community support provider under Medicaid waiver arrangements rather than as a medical/acute-care provider. Given the lack of Medicare activity, payer strategy and financial risk appear concentrated on state Medicaid policy and waiver funding levels.

Medicaid: Complete Services Breakdown

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

7 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	84,250	$320	$26.6M
T2033	Residential care, not otherwise specified (nos), waiver; per diem	83,150	$180	$14.7M
H2021	Community-based wrap-around services, per 15 minutes	33,120	$200	$6.5M
T2021	Day habilitation, waiver; per 15 minutes	8,970	$90	$789.7K
T1002	Rn services, up to 15 minutes	1,250	$120	$147K
T2025	Waiver services; not otherwise specified (nos)	150	$960	$143.2K
T1005	Respite care services, up to 15 minutes	280	$140	$38.8K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

Ability First, LLC — 0 of 7 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

7 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	11	40	54,080	$360	$22.1M
T2033	Residential care, not otherwise specified (nos), waiver; per diem	7	40	11,070	$280	$10.8M
H2021	Community-based wrap-around services, per 15 minutes	7	60	6,750	$340	$4.4M
T2021	Day habilitation, waiver; per 15 minutes	23	50	6,810	$120	$1.6M
T2025	Waiver services; not otherwise specified (nos)	33	40	1,010	$360	$1.6M
T1005	Respite care services, up to 15 minutes	11	10	2,760	$160	$906.3K
T1002	Rn services, up to 15 minutes	21	40	1,350	$150	$368.7K

Nearby Providers

Other providers in the same ZIP code as Ability First, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
1st Care Of New Mexico LLC	NM	In Home Supportive Care Agency	$0	$86.5M
Community Options, Inc	NM	Child Intellectual and/or Developmental Disabilities Respite Care	$0	$76.7M
Abarim Home Health Care Inc.	NM	Community Based Hospice Care Agency	$0	$66M
New Mexico Department Of Health	NM	Customized Equipment (DME)	$0	$60.4M
Independent Living Resource Center	NM	Personal Care Attendant	$0	$57.7M
Alta Mira Specialized Family Services, Inc.	NM	Community/Behavioral Health Agency	$0	$46.2M
Southwest Family Guidance Center LLC	NM	Adolescent and Children Mental Health Clinic/Center	$0	$32.7M
Aid Home Health Care Services LLC.	NM	Home Health Agency	$0	$32.4M
Active Solutions Incorporated	NM	Developmentally Disabled Services Day Training Agency	$0	$31.3M
Great Livin', LLC	NM	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$27.1M

Ability First, LLC — Billing Profile & Reimbursement Data

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Ability First, 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