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.

Modivcare Solutions, LLC (NPI 1699725143)

Field	Value
Entity Type	Organization
Organization	Modivcare Solutions, LLC
Address	6900 E Layton Ave Ste 1200
City	Denver
State	CO
ZIP	80237
Taxonomy	Transportation Broker
NPI Enumerated	May 12, 2006

Payer Source	Total Paid
Medicaid	$3.1B
Medicare	$0

Key Findings

This entity has no Medicare billing on file and reports Total Medicaid revenue of $3.08B, making it effectively a Medicaid-specialist in the public claims record rather than a dual-payer operator. The absence of Medicare activity means all observed scale, risk, and contracting dynamics in this profile are driven by Medicaid flows.

Taxonomy and top-line code mix indicate MODIVCARE SOLUTIONS, LLC operates primarily as a non-emergency transportation broker: the top revenue-driving codes are A0100 (Non-emergency transportation; taxi), A0130 (Non-emergency transportation: wheelchair van), and A0120 (Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems). These codes’ descriptions and magnitudes are consistent with centralized coordination of high-volume member transports rather than episodic clinical services.

Revenue concentration is extreme: the precomputed top-three codes account for 71.9% of the provider’s total Medicaid revenue, with A0100 at $1.27B (41.2%), A0130 at $655.1M (21.3%), and A0120 at $291M (9.5%). This concentration signals that a very small set of transport services drive most of the $3.08B Medicaid footprint.

MODIVCARE is a dominant in-state provider on core NEMT codes: A0100 ranks #1 of 20 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code), A0130 ranks #1 of 54 providers in-state (100th percentile; extreme outlier), and A0120 ranks #1 of 161 providers in-state (100th percentile; extreme outlier). These rankings indicate market leadership for the primary non-emergency transport categories in Colorado.

Beyond the top three, the provider also reports material ambulance and mileage lines: A0428 (BLS non-emergency) at $285M (9.3%) ranks #1 of 52 providers in-state (100th percentile; extreme outlier), A0090 (per mile—individual with vested interest) at $208.7M (6.8%) ranks #1 of 11 providers in-state (100th percentile; extreme outlier), and T2003 (encounter/trip) at $123M (4.0%) ranks #1 of 283 providers in-state (100th percentile; extreme outlier). This mix shows substantial vertical breadth across both non-emergency and some ambulance-related transport services.

A number of specialty transport and ancillary codes besides the main NEMT trio are also flagged as statistical outliers or top-ranked in-state: examples include A0427, A0429, A0426, and A0422 (each with in-state #1 ranks and labels such as 100th percentile or extreme outlier), and high-cost episodic codes like A0180 at $17.9M. The breadth of extreme outlier rankings suggests statewide concentration across multiple transport modalities rather than concentration in a single isolated code.

The provider’s NPI enumeration date is 2006-05-12 (~20 years ago), indicating long tenure in the claims system. That longevity, combined with the $3.08B Medicaid lifetime revenue and repeated #1 in-state rankings, suggests established operational scale and a sustained role in Colorado’s Medicaid transport network.

From a payer-oversight and network perspective, the profile’s heavy revenue concentration and repeated "extreme outlier" / 100th percentile rankings across many transport codes merit targeted review of utilization patterns, pricing agreements, and network contracting given the asymmetric exposure: a handful of codes account for the majority of spend and the provider consistently ranks far above typical state volumes.

Medicaid: Complete Services Breakdown

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

44 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
A0100	Non-emergency transportation; taxi	38,422,250	$30	$1.3B
A0130	Non-emergency transportation: wheelchair van	12,845,880	$50	$655.1M
A0120	Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems	7,658,270	$40	$291M
A0428	Ambulance service, basic life support, non-emergency transport, (bls)	2,209,340	$130	$285M
A0090	Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest	9,484,820	$20	$208.7M
T2003	Non-emergency transportation; encounter/trip	9,460,190	$10	$123M
A0425	Ground mileage, per statute mile	8,866,850	$10	$79.8M
A0110	Non-emergency transportation and bus, intra or inter state carrier	11,668,210	$1	$35M
T2005	Non-emergency transportation; stretcher van	193,330	$130	$25.7M
S0215	Non-emergency transportation; mileage, per mile	4,162,860	$10	$20.8M

Showing 1–10 of 44

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

Modivcare Solutions, LLC — 16 of 25 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

44 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
A0100	Non-emergency transportation; taxi	1	20	4,940	$30	$65.9M
T2005	Non-emergency transportation; stretcher van	1	10	193,330	$130	$25.6M
S0215	Non-emergency transportation; mileage, per mile	1	10	4,162,860	$10	$21.5M
A0090	Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest	1	10	1,740	$20	$18.8M
A0130	Non-emergency transportation: wheelchair van	1	50	350	$50	$12.3M
A0110	Non-emergency transportation and bus, intra or inter state carrier	1	10	1,400	$1	$12.3M
A0428	Ambulance service, basic life support, non-emergency transport, (bls)	1	50	360	$130	$5.6M
A0180	Non-emergency transportation: ancillary: lodging-recipient	1	10	2,680	$290	$5.3M
A0380	Bls mileage (per mile)	1	10	54,400	$70	$4M
A0140	Non-emergency transportation and air travel (private or commercial) intra or inter state	1	10	15,760	$170	$2.7M

Showing 1–10 of 44

Nearby Providers

Other providers in the same ZIP code as Modivcare Solutions, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Zynex Medical Inc	CO	Durable Medical Equipment & Medical Supplies	$0	$32.7M
High Five Home Care LLC.	CO	In Home Supportive Care Agency	$0	$5.8M
Daniel Callaghan	CO	Dermatology Physician	$604.4K	$0
Pradeep Rai	CO	Surgery Physician	$98.7K	$0
Donald Forest	CO	Internal Medicine Physician	$76.3K	$0
Ashley Chen	CO	Family Medicine Physician	$70.6K	$0
Frederick Mechanik	CO	Primary Podiatric Medicine Podiatrist	$61.7K	$0
Fernando Guarderas	CO	Family Medicine Physician	$36.5K	$0
Steven Wilk	CO	Dentist	$14.4K	$0
Steven Milo	CO	Anesthesiology Physician	$4.9K	$0

Modivcare Solutions, LLC — Billing Profile & Reimbursement Data

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Modivcare Solutions, LLC — 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