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

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

Sample Supports (NPI 1649577453)

Field	Value
Entity Type	Organization
Organization	Sample Supports
Address	606 Mountain View Ave
City	Longmont
State	CO
ZIP	80501
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	February 15, 2011

Payer Source	Total Paid
Medicaid	$105.8M
Medicare	$0

Key Findings

SAMPLE SUPPORTS is effectively a single-payer Medicaid provider: there is no Medicare billing on file and its lifetime Medicaid revenue is $105.8M, indicating the organization’s scale and operations are concentrated almost entirely in the Medicaid market. This payer concentration means the provider’s financial performance is tightly linked to state Medicaid policy and waiver program reimbursement.

Revenue is highly concentrated in a small set of habilitation and day-service codes: the precomputed top three Medicaid codes account for 84.0% of total Medicaid revenue, driven by T2016 ($56.7M, 53.6%), T2019 ($17.6M, 16.7%), and T2021 ($14.5M, 13.7%). This concentration indicates that a few service lines are the primary revenue engines for the organization.

The code mix points to a service model focused on waiver-based habilitation and community supports: T2016 (Habilitation, residential, waiver; per diem), T2019 (supported employment, waiver; per 15 minutes), T2021 (Day habilitation, waiver; per 15 minutes), and H2019 (Therapeutic behavioral services, per 15 minutes) together show the provider delivers residential habilitation, day programs, employment supports, and intensive behavioral services. That operational profile is consistent with a Community/Behavioral Health Agency specializing in Medicaid waiver populations and long-term support services.

SAMPLE SUPPORTS is a statewide leader on several codes: T2019 ranks #2 of 102 providers in-state (99th percentile; extreme outlier) and H2019 ranks #1 of 99 providers in-state (100th percentile; extreme outlier), signaling unusually high volume in supported employment and therapeutic behavioral services relative to peers. Those rankings suggest the provider holds dominant market share for those specific service lines within Colorado.

The provider’s competitive position is mixed across its top habilitation codes: T2016 (residential habilitation) ranks #25 of 191 providers in-state (87th percentile; typical, unremarkable volume for this code), while T2021 (day habilitation) ranks #10 of 290 (97th percentile; notably above typical state volume). In other words, SAMPLE SUPPORTS is exceptionally large for some Medicaid services but more typical in others, indicating targeted strengths rather than uniform dominance across all habilitation offerings.

Ancillary Medicaid services account for modest shares of revenue and illustrate breadth of operations: T2003 (Non-emergency transportation; encounter/trip) generated $3.3M across 52.6K claims (3.1% of Medicaid revenue) and ranks #18 of 283 providers in-state (94th percentile), while S5130 (Homemaker) and T1019 (Personal care services) are present but each contribute under 1% of revenue. These lines show the organization provides transportation and personal-care supports as complementary services to its primary habilitation and behavioral programs.

There are notable reporting anomalies worth flagging for further review: T2034 (Crisis intervention, waiver; per diem) shows 5K claims with $0 avg paid/claim and $0 revenue and ranks #4 of 162 providers in-state (98th percentile; extreme outlier). The presence of a high claim count with zero reported revenue may reflect contract carve-outs, encounter-only reporting, or other administrative factors rather than paid service revenue.

The provider has an established operational tenure: its NPI was enumerated on 2011-02-15 (~15 years ago), indicating a sustained presence in the state Medicaid market. Given the business mix and high concentration in waiver habilitation and behavioral codes, SAMPLE SUPPORTS’ financial outlook and growth prospects will be particularly sensitive to state waiver enrollment, rate-setting, and policy changes affecting community-based long-term support services.

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	64,730	$880	$56.7M
T2019	Habilitation, supported employment, waiver; per 15 minutes	55,610	$320	$17.6M
T2021	Day habilitation, waiver; per 15 minutes	78,580	$180	$14.5M
H2019	Therapeutic behavioral services, per 15 minutes	132,620	$70	$9.8M
T2003	Non-emergency transportation; encounter/trip	52,640	$60	$3.3M
T2024	Service assessment/plan of care development, waiver	15,430	$100	$1.5M
H2023	Supported employment, per 15 minutes	5,830	$120	$705.8K
S5130	Homemaker service, nos; per 15 minutes	12,380	$50	$656.1K
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…	13,020	$40	$572.7K
H2021	Community-based wrap-around services, per 15 minutes	9,900	$40	$425.9K

Showing 1–10 of 12

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Colorado Distribution

Sample Supports — 3 of 11 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Colorado

Full comparison — all codes billed, vs. Colorado median

12 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	25	190	3,890	$290	$12.4M
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…	156	480	5,200	$150	$3.5M
T2021	Day habilitation, waiver; per 15 minutes	10	290	3,700	$160	$2.3M
T2019	Habilitation, supported employment, waiver; per 15 minutes	2	100	1,940	$200	$1.5M
S5130	Homemaker service, nos; per 15 minutes	78	340	3,530	$80	$1.2M
H2021	Community-based wrap-around services, per 15 minutes	11	100	960	$100	$1.1M
T2003	Non-emergency transportation; encounter/trip	18	280	2,640	$20	$881.3K
H2019	Therapeutic behavioral services, per 15 minutes	1	100	1,090	$90	$600.8K
T2024	Service assessment/plan of care development, waiver	7	70	880	$90	$455.1K
T2004	Non-emergency transport; commercial carrier, multi-pass	34	40	1,390	$10	$303.7K

Showing 1–10 of 12

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Salud Family Health	CO	Federally Qualified Health Center (FQHC)	$0	$25.7M
Carmel Community Living Corporation	CO	Developmentally Disabled Services Day Training Agency	$0	$21.2M
Elevated Supports, LLC	CO	Respite Care	$0	$14.6M
Hero Dental Of Longmont PC	CO	General Practice Dentistry	$0	$13M
Hopelight Medical Clinic	CO	Health Service Clinic/Center	$0	$12.3M
Hero Vision Of Longmont, LLC	CO	Optometrist	$0	$11.9M
Senior Housing Options, Inc.	CO	Assisted Living Facility	$0	$5.7M
Vcphcs X, LLC	CO	Substance Use Disorder Rehabilitation Clinic/Center	$156.9K	$5.3M
Longmont United Hospital	CO	General Acute Care Hospital	$0	$5.2M
Community Advantage, Inc.	CO	Developmentally Disabled Services Day Training Agency	$0	$3.6M

Sample Supports — Billing Profile & Reimbursement Data

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Sample Supports — 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