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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Pinnacle Home Care, Inc. (NPI 1669541538)

Field	Value
Entity Type	Organization
Organization	Pinnacle Home Care, Inc.
Address	903 E Arlington Blvd
City	Greenville
State	NC
ZIP	27858
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	November 7, 2006

Payer Source	Total Paid
Medicaid	$59.3M
Medicare	$0

Key Findings

This provider is effectively a single-payer Medicaid operator: there is no Medicare billing on file and total Medicaid revenue on file is $59.3M. The absence of Medicare activity means analyses should focus exclusively on Medicaid-funded service lines and waiver programs when assessing revenue drivers and utilization patterns for this entity.

Revenue is highly concentrated in a very small set of waiver and habilitation codes: the precomputed top three Medicaid codes account for 95.4% of this provider's total Medicaid revenue. The three codes driving that concentration are T2013 ($38.9M, 65.6%), T2012 ($15.6M, 26.4%), and S5150 ($2M, 3.4%), indicating a narrow revenue base focused on a few service types.

The code mix and taxonomy are consistent with a day habilitation/waiver services operation: T2013 (Habilitation, educational, waiver; per hour) and T2012 (Habilitation, educational; waiver, per diem) together make up the bulk of revenue, while S5150 (Unskilled respite care, not hospice; per 15 minutes) and H2015 (Comprehensive community support services, per 15 minutes) appear as complementary service lines. This pattern aligns with the provider's taxonomy as a Developmentally Disabled Services Day Training Agency and points to delivery of waiver-funded day training, habilitation, and respite supports rather than acute clinical care.

T2013 is the dominant single driver of revenue and a standout statewide: the provider reported 207.9K claims for T2013 at an average paid/claim of $187 and $38.9M revenue (65.6% of Medicaid revenue), ranking #13 of 185 providers in-state and characterized as notably above typical state volume for this code. That combination of very high claim volume and above-typical state ranking indicates this provider is a major throughput provider for per-hour habilitation services within North Carolina's waiver system.

T2012 is the secondary habilitation revenue stream with substantial volume but a less exceptional competitive position: it shows 73.1K claims, $214 avg paid/claim, and $15.6M revenue (26.4% of Medicaid revenue), ranking #13 of 110 providers in-state and described as typical, unremarkable volume. Together with T2013, T2012 confirms the provider relies primarily on waiver habilitation reimbursement modalities (hourly and per-diem) rather than a more diversified CPT mix.

S5150 and other supportive codes contribute only modestly to revenue but reflect breadth of non-clinical supports: S5150 recorded 28.8K claims, $71 avg paid/claim, and $2M revenue (3.4% of Medicaid revenue), ranking #21 of 168 providers in-state and described as typical, unremarkable volume. H2015 ($1.5M, 2.6%) and H0045 ($1.2M, 2.0%) round out smaller service streams, suggesting the provider offers respite and community support in addition to core habilitation services but does not materially diversify its revenue base.

Across competitive standing and risk considerations, the provider is a major statewide participant in habilitation services (especially for T2013) but not the single dominant operator: ranking #13 for T2013 and T2012 places it in high percentiles (93rd and 89th respectively), indicating above-average scale, yet other providers still out-rank it. The very high revenue concentration (95.4% in top three codes) elevates sensitivity to policy or rate changes affecting those specific waiver codes.

The provider has an established tenure in the market, with an NPI enumerated on 2006-11-07 (~20 years ago), which, combined with sustained Medicaid receipts totaling $59.3M, implies a long-standing operational footprint in state waiver and developmental disability service delivery. Analysts should consider this longevity when evaluating contract stability, payer relationships, and potential capacity to absorb regulatory or reimbursement shifts in North Carolina's Medicaid waiver programs.

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
T2013	Habilitation, educational, waiver; per hour	207,940	$190	$38.9M
T2012	Habilitation, educational; waiver, per diem	73,100	$210	$15.6M
S5150	Unskilled respite care, not hospice; per 15 minutes	28,770	$70	$2M
H2015	Comprehensive community support services, per 15 minutes	15,030	$100	$1.5M
H0045	Respite care services, not in the home, per diem	12,570	$90	$1.2M

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

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

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2013	Habilitation, educational, waiver; per hour	13	190	29,090	$150	$9.1M
T2012	Habilitation, educational; waiver, per diem	13	110	21,340	$180	$6.1M
H2015	Comprehensive community support services, per 15 minutes	101	250	10,060	$130	$2.4M
H0045	Respite care services, not in the home, per diem	20	80	4,450	$100	$993.7K
S5150	Unskilled respite care, not hospice; per 15 minutes	21	170	4,310	$80	$958.4K

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Pride In North Carolina, LLC	NC	Community/Behavioral Health Agency	$0	$98.2M
East Carolina University	NC	Internal Medicine Physician	$0	$53.7M
Easter Seals Ucp Nc & Va, Inc.	NC	Community/Behavioral Health Agency	$0	$38.8M
Maxim Healthcare Services, Inc.	NC	Home Health Agency	$0	$35M
Pathways To Life, Inc	NC	Community/Behavioral Health Agency	$0	$30.4M
Behavioral Framework Nc LLC	NC	Behavior Analyst	$0	$29.4M
Venture Rehabilitation Group	NC	Speech-Language Pathologist	$0	$16M
At Home Personal Care Services,inc. Of North Carolina	NC	Home Health Agency	$0	$14.5M
East Carolina Home Care	NC	In Home Supportive Care Agency	$0	$14.5M
Carolina Therapy Connection, PC	NC	Pediatric Occupational Therapist	$0	$12.5M

Pinnacle Home Care, Inc. — Billing Profile & Reimbursement Data

Sign up for Pinnacle Home Care, Inc. — Billing Profile & Reimbursement Data policy alerts

Pinnacle Home Care, Inc. — Billing Profile & Reimbursement Data

Sign up for Pinnacle Home Care, Inc. — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References