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

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

Waypoint Maine, Inc. (NPI 1649495110)

Field	Value
Entity Type	Organization
Organization	Waypoint Maine, Inc.
Address	5 Dunaway Dr
City	Sanford
State	ME
ZIP	04073
Taxonomy	Case Management Agency
NPI Enumerated	April 17, 2007

Payer Source	Total Paid
Medicaid	$110.5M
Medicare	$0

Key Findings

WAYPOINT MAINE, INC. is effectively a Medicaid-focused provider: there is no Medicare billing on file while total Medicaid revenue is reported as $110.5M, indicating the organization's commercial footprint within Medicare is nil and its financial exposure is concentrated in state Medicaid programs. The NPI was enumerated 2007-04-17 (~19 years ago), showing a long-tenured presence in the market that aligns with the scale of its reported Medicaid activity.

Revenue is highly concentrated in a narrow set of habilitation and day-services codes: the top three Medicaid codes (T2016, H2012, T2021) account for 85.1% of the provider’s total Medicaid revenue, with T2016 alone representing $71.5M (64.7% of total Medicaid revenue). This concentration signals that residential habilitation (T2016 – per diem) is the dominant service line driving the business, with per-diem payments (reported $8943 avg paid/claim) forming the bulk of cash flow.

The code mix indicates an operational focus on residential and day habilitation plus behavioral health day treatment: T2016 (Habilitation, residential, waiver; per diem), T2021 (Day habilitation, waiver; per 15 minutes), and H2012 (Behavioral health day treatment, per hour) together generate the majority of Medicaid revenue, consistent with an organization operating large residential programs and organized day services for individuals with developmental or behavioral needs. The presence of S5140 (Foster care, adult; per diem) and H2023 (Supported employment) as smaller revenue lines suggests complementary service offerings rather than primary business lines.

Despite large absolute Medicaid revenue, the provider is not a statewide dominant payer for its largest code on a relative ranking basis: T2016 ranks #37 of 75 providers in-state (51st percentile), characterized as typical, unremarkable volume for that code. Similarly, H2012 (rank #16 of 42, 63rd percentile) and T2021 (rank #26 of 72, 65th percentile) are described as typical volumes in-state, indicating the organization captures substantial dollars primarily because of high per-diem valuation and scale rather than clear top-market share in the state for those service types.

Several case-management and care coordination codes show meaningful utilization patterns that complement the habilitation services: T1017 (Targeted case management, each 15 minutes) appears with 60.4K claims and $2.8M revenue and is flagged as an extreme outlier (ranks #1 of 104 providers in-state, 100th percentile), signaling unusually heavy use of targeted case management relative to peers. G9012 (Other specified case management) also shows high claim volume (56K claims, $4.8M revenue) and ranks #11 of 50 (80th percentile), which together suggest case management and coordination are significant operational components and potential differentiators for the organization.

Payer mix and risk profile: because there is no Medicare billing on file, the organization is effectively single-payer dependent on Medicaid ($110.5M) which concentrates reimbursement policy risk with Maine Medicaid. The absence of Medicare revenue limits diversification of reimbursement sources and makes state policy, waiver rules, and per-diem/waiver rates the primary drivers of financial performance.

Competitive nuances appear code-specific: the provider is a clear outlier in targeted case management (T1017) where it ranks #1 of 104 providers and is described as an extreme outlier, far above typical state volume, suggesting either a programmatic emphasis or contractual role in case management. By contrast, for high-revenue habilitation codes (T2016, H2012, T2021) the provider sits in mid-range percentiles (51st–65th), so its market position for core residential and day habilitation services is meaningful but not dominant statewide.

Operational signals from unit rates and claim counts: T2016 shows high avg paid/claim ($8943) with 8K claims producing $71.5M in revenue, indicating that per-diem residential habilitation is the primary revenue generator by dollar value, while high-claim, low-unit-value codes like T1017 (60.4K claims, $46 avg paid/claim) drive volume and reflect labor- or time-intense case management activities rather than large per-claim revenue. These contrasting dynamics (high-dollar per-diem services plus high-volume case management) describe a blended operating model that pairs residential/day services with intensive care coordination.

Medicaid: Complete Services Breakdown

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

12 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	7,990	$8,940	$71.5M
H2012	Behavioral health day treatment, per hour	22,730	$650	$14.7M
T2021	Day habilitation, waiver; per 15 minutes	23,370	$340	$7.9M
G9012	Other specified case management service not elsewhere classified	56,020	$90	$4.8M
T2017	Habilitation, residential, waiver; 15 minutes	9,190	$480	$4.4M
S5140	Foster care, adult; per diem	1,070	$3,540	$3.8M
T1017	Targeted case management, each 15 minutes	60,350	$50	$2.8M
G9007	Coordinated care fee, scheduled team conference	3,460	$80	$280.4K
H2023	Supported employment, per 15 minutes	700	$310	$220.4K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	5,400	$40	$210.4K

Showing 1–10 of 12

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Maine Distribution

Waypoint Maine, Inc. — 1 of 12 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Maine

Full comparison — all codes billed, vs. Maine median

12 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	37	80	7,300	$1,670	$30.8M
S5140	Foster care, adult; per diem	25	30	9,310	$530	$13.6M
T2021	Day habilitation, waiver; per 15 minutes	26	70	13,340	$200	$5.1M
H2012	Behavioral health day treatment, per hour	16	40	13,180	$230	$5.1M
G9012	Other specified case management service not elsewhere classified	11	50	25,820	$80	$3M
T2017	Habilitation, residential, waiver; 15 minutes	17	30	8,960	$260	$3M
T1017	Targeted case management, each 15 minutes	1	100	4,690	$90	$1M
H0004	Behavioral health counseling and therapy, per 15 minutes	121	290	860	$80	$805.1K
H2023	Supported employment, per 15 minutes	20	20	2,330	$160	$673K
G9007	Coordinated care fee, scheduled team conference	6	30	950	$60	$258.2K

Showing 1–10 of 12

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Great Bay Services	ME	Developmental Disabilities Clinic/Center	$0	$7.1M
Milestones Family Services, LLC	ME	Case Management Agency	$0	$2.8M
City Of Sanford	ME	Land Ambulance	$277.3K	$1.8M
Montshire Sanford PC	ME	Pediatric Dentistry	$0	$1.4M
Great Bay Services	ME	Developmental Disabilities Clinic/Center	$0	$824.9K
Philip Russell	ME	Psychiatry Physician	$14.5K	$720.3K
City Of Sanford	ME	Local Education Agency (LEA)	$0	$733.4K
Associated Eye Care, P.A.	ME	Optometrist	$0	$687.3K
Children's Dentistry Of Sanford, LLP	ME	Pediatric Dentistry	$0	$673.4K
Dana Graichen	ME	Ophthalmology Physician	$649.6K	$0

Waypoint Maine, Inc. — Billing Profile & Reimbursement Data

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Waypoint Maine, 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