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

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

Transitions, Inc. (NPI 1487791364)

Field	Value
Entity Type	Organization
Organization	Transitions, Inc.
Address	520 Lomax St
City	Idaho Falls
State	ID
ZIP	83401
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	January 31, 2007

Payer Source	Total Paid
Medicaid	$7.8M
Medicare	$0

Key Findings

This provider effectively operates as a Medicaid-only biller: there is no Medicare billing on file while total Medicaid revenue is $7.8M, so Medicaid represents the entirety of reported lifetime revenue. The absence of Medicare activity means payer risk and strategic exposure are concentrated in state Medicaid policy and rates.

Revenue is extremely concentrated in a very small set of services: the precomputed top three Medicaid codes by revenue account for 97.0% of this provider's total Medicaid revenue. Those top three are H0004 ($6.1M, 77.8% of Medicaid revenue), H2019 ($1M, 13.3%), and 96152 ($464.6K, 5.9%), indicating that a handful of service lines drive nearly all earnings.

The code mix and descriptions point to a core operation focused on community behavioral health and hands-on therapeutic services. H0004 (Behavioral health counseling and therapy, per 15 minutes) and H2019 (Therapeutic behavioral services, per 15 minutes) together dominate revenue, which aligns with the provider taxonomy of Developmentally Disabled Services Day Training Agency and suggests the organization primarily delivers frequent, short-interval behavioral interventions.

Service volume is high for H0004 and meaningful but smaller for H2019: the provider submitted 35.6K claims for H0004 and 8.1K claims for H2019, reflecting a heavy throughput model of per-15-minute sessions. H0004 ranks #15 of 157 in-state (91th percentile) while H2019 ranks #12 of 60 (81th percentile), and both are labeled as "typical, unremarkable volume for this code," indicating solid utilization without clear extreme specialization.

Payment profile across codes shows variation in average paid-per-claim: H0004 averages $171 paid/claim, H2019 averages $128, and 96152 averages $157; lower-reimbursed services include H2015 at $60 paid/claim and T1027 at $21 paid/claim. This mix means revenue is driven more by repetition/volume of higher-rate per-15-minute behavioral codes than by higher-dollar single claims, concentrating financial performance on both utilization and modest per-unit rates.

Competitive standing is mixed by code: the provider ranks relatively high in the state on H0004 (91th percentile) and H2019 (81th percentile), but is mid-range on 96152 (rank #30 of 73, 60th percentile) and H2015 (50th percentile). These positions suggest the organization is a meaningful regional participant for core behavioral codes but not an overwhelmingly dominant statewide specialist across the broader set of service categories.

Operationally, the provider’s dependence on per-15-minute behavioral codes creates concentration risk: with H0004 and H2019 comprising the vast majority of revenue and the top three codes accounting for 97.0% of Medicaid revenue, changes in reimbursement rules or utilization patterns for these codes could materially impact total income. The absence of Medicare revenue further reduces diversification of payer risk.

The provider has long tenure in the Medicaid ecosystem, with its NPI enumerated on 2007-01-31 (~19 years ago), which supports existing relationships and operational experience in delivering day-training and behavioral services over an extended period. This longevity, combined with high claim volumes for key codes, indicates established workflows and a stable service footprint within Idaho’s behavioral health network.

Medicaid: Complete Services Breakdown

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

5 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0004	Behavioral health counseling and therapy, per 15 minutes	35,630	$170	$6.1M
H2019	Therapeutic behavioral services, per 15 minutes	8,100	$130	$1M
96152	N/A	2,960	$160	$464.6K
H2015	Comprehensive community support services, per 15 minutes	2,960	$60	$177.7K
T1027	Family training and counseling for child development, per 15 minutes	2,590	$20	$54.4K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Transitions, Inc. — 0 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0004	Behavioral health counseling and therapy, per 15 minutes	15	160	4,020	$140	$1.6M
H2019	Therapeutic behavioral services, per 15 minutes	12	60	2,960	$120	$609.8K
96152	N/A	30	70	2,270	$80	$608.8K
H2015	Comprehensive community support services, per 15 minutes	23	50	2,960	$100	$570.3K
T1027	Family training and counseling for child development, per 15 minutes	11	40	1,050	$40	$66.8K

Nearby Providers

Other providers in the same ZIP code as Transitions, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bonneville School Dist #93	ID	Local Education Agency (LEA)	$0	$27.5M
Idaho Falls School District 91	ID	Local Education Agency (LEA)	$0	$11.2M
Affiliates Inc.	ID	Developmentally Disabled Services Day Training Agency	$0	$9.9M
Innovative Health Care Concepts, Inc	ID	Case Manager/Care Coordinator	$0	$5.7M
Stewards Of Recovery	ID	Community/Behavioral Health Agency	$0	$5.1M
Joshua D. Smith Foundation	ID	Developmentally Disabled Services Day Training Agency	$0	$4.1M
See Opportunities And Achieve Results	ID	Case Management Agency	$0	$3.8M
Porter Eyecare PLLC	ID	Optometrist	$0	$3.1M
Denture Clinic Inc	ID	Dental Laboratory	$0	$3M
Childrens Supportive Services Incorporated	ID	Social Worker	$0	$3M

Transitions, Inc. — Billing Profile & Reimbursement Data

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Transitions, Inc. — 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