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

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

Mystic Valley Elder Services, Inc. (NPI 1578683694)

Field	Value
Entity Type	Organization
Organization	Mystic Valley Elder Services, Inc.
Address	300 Commercial St Ste 19
City	Malden
State	MA
ZIP	02148
Taxonomy	Case Management Agency
NPI Enumerated	March 30, 2007

Payer Source	Total Paid
Medicaid	$222.7M
Medicare	$0

Key Findings

This provider is effectively a single‑payer Medicaid operator: there is no Medicare billing on file and reported lifetime Medicaid revenue is $222.7M. The absence of Medicare claims suggests the organization’s revenue, contracting, and clinical operations are concentrated in state Medicaid programs rather than Medicare fee‑for‑service or Medicare Advantage lines.

Revenue is highly concentrated in a very small set of service codes: the top three Medicaid codes (G0156, T1019, S5125) together account for 80.2% of this provider’s total Medicaid revenue. Individually those codes are G0156 (37.8% of revenue, $84.1M), T1019 (32.9% of revenue, $73.3M), and S5125 (9.5% of revenue, $21.2M), indicating reliance on a narrow mix of in‑home support services.

The code mix and descriptions point to a home‑and‑community‑based services (HCBS) / long‑term services and supports (LTSS) operating model: G0156 is home health/hospice aide time, T1019 is personal care per 15 minutes, and S5125 is attendant care per 15 minutes. Significant billing for S5130 (homemaker services), S5170 (home delivered meals), S5165 (home modifications) and S5175 (laundry) further indicates the provider offers a broad set of in‑home support and social‑care wraparound services beyond skilled nursing.

Competitive standing is mixed across service lines: for personal care (T1019) the provider ranks #13 of 137 in‑state (91st percentile), marking it as a major statewide participant in that service. By contrast, for home health/hospice aide time (G0156) it ranks #70 of 193 (64th percentile) and for attendant care (S5125) it ranks #12 of 40 (72nd percentile), both characterized as typical or unremarkable relative to peers.

Several non‑clinical support codes are statistical outliers in the state, highlighting specific strengths in ancillary HCBS offerings: S5130 (homemaker) is at the 94th percentile (#10 of 162), S5170 (home delivered meals) is 93rd percentile (#5 of 62), S5175 (laundry) is 95th percentile (#3 of 40), S5165 (home modifications) is 94th percentile (#3 of 35), and S5120 (chore services per 15 minutes) is 97th percentile (#2 of 31). The dataset labels these as "notably above typical state volume," suggesting the provider has built scale in operational, non‑clinical supports that complement direct personal care.

Operationally the provider shows a high‑volume, low‑unit‑value service pattern consistent with labor‑intensive home care: T1019 has 166.5K claims, S5130 has 212K claims, and S5170 has 356.6K claims, while G0156 accounts for 23.5K claims. This claim profile implies extensive workforce deployment and administrative capacity to manage many short‑duration encounters rather than a small number of high‑value procedures.

The concentration of revenue in a few Medicaid codes creates exposure to Medicaid policy and rate changes: with 80.2% of Medicaid revenue coming from G0156, T1019, and S5125, any state reimbursement adjustments or eligibility shifts for these services would disproportionately affect overall revenue. The provider’s business continuity and growth prospects will therefore be sensitive to state HCBS reimbursement policy and managed‑care contracting.

The provider has an established presence in the market, with its NPI enumerated on 2007-03-30 (~19 years ago). That tenure, together with high statewide ranks in several homemaker and support categories, is consistent with a long‑standing role in Massachusetts’ Medicaid HCBS network rather than a new entrant or purely episodic billing entity.

Medicaid: Complete Services Breakdown

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

24 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
G0156	Services of home health/hospice aide in home health or hospice settings, each 15 minutes	23,500	$3,580	$84.1M
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	166,500	$440	$73.3M
S5125	Attendant care services; per 15 minutes	8,390	$2,520	$21.2M
S5130	Homemaker service, nos; per 15 minutes	211,970	$90	$19.1M
S5170	Home delivered meals, including preparation; per meal	356,560	$30	$9.6M
S5102	Day care services, adult; per diem	18,630	$210	$3.9M
S5175	Laundry service, external, professional; per order	105,250	$30	$2.7M
T2003	Non-emergency transportation; encounter/trip	19,980	$110	$2.2M
S5135	Companion care, adult (e.g., iadl/adl); per 15 minutes	21,570	$100	$2.2M
S5165	Home modifications; per service	5,450	$250	$1.4M

Showing 1–10 of 24

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Massachusetts Distribution

Mystic Valley Elder Services, Inc. — 1 of 24 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Massachusetts

Full comparison — all codes billed, vs. Massachusetts median

24 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	13	140	7,990	$90	$61.6M
T2023	Targeted case management; per month	55	70	8,210	$510	$8.6M
S5125	Attendant care services; per 15 minutes	12	40	3,390	$300	$4.7M
T1020	Personal care services, per diem, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	36	50	11,820	$40	$4.4M
S5102	Day care services, adult; per diem	205	340	25,780	$110	$4.1M
S5130	Homemaker service, nos; per 15 minutes	10	160	7,330	$90	$3.8M
G0156	Services of home health/hospice aide in home health or hospice settings, each 15 minutes	70	190	14,240	$110	$3.7M
S5100	Day care services, adult; per 15 minutes	143	190	2,000	$230	$3.1M
T2022	Case management, per month	46	80	7,230	$50	$2.6M
S5170	Home delivered meals, including preparation; per meal	5	60	50,010	$20	$2.5M

Showing 1–10 of 24

Nearby Providers

Other providers in the same ZIP code as Mystic Valley Elder Services, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Ag Adult Foster Care LLC	MA	Adult Care Home Facility	$0	$32.3M
Mystic Valley Elder Services, Inc.	MA	Case Management Agency	$0	$24M
Greater Malden Behavioral Health, Inc	MA	Community/Behavioral Health Agency	$0	$22.2M
De-light Medicals Inc	MA	Durable Medical Equipment & Medical Supplies	$0	$10.1M
Adult Day Health, Inc.	MA	Adult Day Care Clinic/Center	$0	$8.8M
Eastern Middlesex Alcoholism Services, Inc	MA	Substance Abuse Rehabilitation Facility	$0	$6M
Albert Daly	MA	Primary Podiatric Medicine Podiatrist	$462.1K	$0
Jack Daly	MA	Primary Podiatric Medicine Podiatrist	$410.6K	$0
Emma Chu	MA	Optometrist	$242.6K	$90
Nicholas Kovacev	MA	Physical Therapist	$152.8K	$10.7K

Mystic Valley Elder Services, Inc. — Billing Profile & Reimbursement Data

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Mystic Valley Elder Services, 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