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

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

The Arc Of Essex County, Inc (NPI 1497136592)

Field	Value
Entity Type	Organization
Organization	The Arc Of Essex County, Inc
Address	123 Naylon Ave
City	Livingston
State	NJ
ZIP	07039
Taxonomy	In Home Supportive Care Agency
NPI Enumerated	June 15, 2015

Payer Source	Total Paid
Medicaid	$158.9M
Medicare	$0

Key Findings

THE ARC OF ESSEX COUNTY, INC presents as an effectively single-payer provider: there is no Medicare billing on file while lifetime Medicaid revenue totals $158.9M. This concentration on Medicaid indicates the organization’s financial footprint and payer relationships are overwhelmingly state-program driven rather than split across Medicare/Medicaid lines.

Revenue is highly concentrated in a very small set of service codes: H2016 ($123.6M, 77.8% of Medicaid revenue), T2021 ($31.8M, 20.0%), and T1005 ($1.8M, 1.2%) together account for 99.0% of the provider’s Medicaid revenue. That degree of concentration suggests core operational capacity and reimbursement dependency lie with these three program/service lines.

The code mix points to a service model focused on community-based supports and day habilitation: H2016 (Comprehensive community support services, per diem) and T2021 (Day habilitation, waiver; per 15 minutes) are the two dominant codes, with T1005 (Respite care services) as a smaller but material adjunct. In practice this pattern is consistent with an agency providing intensive community supports and structured day programs rather than medical or acute skilled services.

H2016 shows large absolute scale (316.2K claims, $391 avg paid/claim, $123.6M revenue) and ranks #12 of 206 providers in-state (95th percentile; notably above typical state volume for this code), indicating the provider is a major in New Jersey for comprehensive community support services. That placement suggests strong capacity or contract relationships to deliver per‑diem community support at volumes well above most peers.

T2021 is an extreme statewide outlier in volume and revenue: 269.9K claims, $118 avg paid/claim, $31.8M revenue and a rank of #3 of 218 providers in-state (99th percentile; extreme outlier, far above typical state volume for this code). This rank and claim count position THE ARC OF ESSEX COUNTY as one of the dominant providers of day habilitation services in New Jersey and a primary contributor to statewide utilization for this waiver service.

T1005 (16.4K claims, $113 avg paid/claim, $1.8M revenue) ranks #1 of 42 providers in-state (100th percentile; notably above typical state volume for this code), signaling leadership in respite care delivery among New Jersey waiver providers. Even though T1005 represents a small share of total Medicaid revenue (1.2%), being the top-ranked provider for this code suggests a strategic or operational emphasis on family/support respite offerings.

Beyond the top three codes, the provider bills smaller volumes for ancillary community services (for example H2021: 12.5K claims, $56 avg paid/claim, $701K revenue; T2036: 3.5K claims, $136 avg paid/claim, $476.1K revenue; A0090: 25.2K claims, $9 avg paid/claim, $226.6K revenue), indicating a portfolio of complementary supports that augment the primary day habilitation and community support operations. These secondary lines together represent a modest share of revenue but reflect breadth in non‑medical wraparound and transportation services.

The provider’s NPI was enumerated on 2015-06-15 (~11 years ago), indicating more than a decade of active enrollment during which it has scaled to the current Medicaid footprint. That tenure combined with the provider’s high state ranks on key codes suggests established programmatic relationships with state waiver and Medicaid payers rather than a recently emerged billing profile.

Medicaid: Complete Services Breakdown

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

8 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2016	Comprehensive community support services, per diem	316,180	$390	$123.6M
T2021	Day habilitation, waiver; per 15 minutes	269,870	$120	$31.8M
T1005	Respite care services, up to 15 minutes	16,360	$110	$1.8M
H2021	Community-based wrap-around services, per 15 minutes	12,520	$60	$701K
T2036	Therapeutic camping, overnight, waiver; each session	3,500	$140	$476.1K
A0090	Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest	25,180	$10	$226.6K
H2015	Comprehensive community support services, per 15 minutes	4,530	$40	$167.8K
H0004	Behavioral health counseling and therapy, per 15 minutes	1,740	$20	$29.5K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Jersey Distribution

The Arc Of Essex County, Inc — 2 of 8 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Jersey

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

8 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2016	Comprehensive community support services, per diem	12	210	23,310	$490	$41.9M
T2021	Day habilitation, waiver; per 15 minutes	3	220	14,500	$170	$7.7M
H2021	Community-based wrap-around services, per 15 minutes	44	190	3,010	$260	$3.1M
H2015	Comprehensive community support services, per 15 minutes	33	110	1,860	$140	$1.1M
T2036	Therapeutic camping, overnight, waiver; each session	2	10	590	$330	$435.8K
T1005	Respite care services, up to 15 minutes	1	40	830	$100	$313.7K
H0004	Behavioral health counseling and therapy, per 15 minutes	30	60	1,570	$70	$253.4K
A0090	Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest	61	230	7,800	$10	$218.8K

Nearby Providers

Other providers in the same ZIP code as The Arc Of Essex County, Inc, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Universal Rehabilitation And Fitness, Inc.	NJ	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$191M
Cooperman Barnabas Medical Center Inc	NJ	General Acute Care Hospital	$0	$136.8M
Pm Pediatrics Of Livingston, PLLC	NJ	Urgent Care Clinic/Center	$0	$40.5M
Jewish Service For The Developmentally Disabled Of Metrowest, Inc.	NJ	Developmentally Disabled Services Day Training Agency	$0	$40.2M
Tyce LLC	NJ	Home Health Agency	$0	$19.3M
The Children's Institute	NJ	Developmentally Disabled Services Day Training Agency	$0	$17.3M
Rwjbh Observation Associates LLC	NJ	Emergency Medicine Physician	$0	$15.9M
Atlantic Ambulance Corp.	NJ	Ambulance	$8.8M	$6.3M
Vitas Healthcare Corporation Atlantic	NJ	Community Based Hospice Care Agency	$0	$11.1M
Saint Barnabas Outpatient Centers	NJ	Radiology Clinic/Center	$3.1M	$5.8M

The Arc Of Essex County, Inc — Billing Profile & Reimbursement Data

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The Arc Of Essex County, 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