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

Why is the Medicaid comparison limited to West Virginia 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. West Virginia (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.

Rem Community Options, Inc. (NPI 1699896316)

Field	Value
Entity Type	Organization
Organization	Rem Community Options, Inc.
Address	748 Mcmechen St
City	Benwood
State	WV
ZIP	26031
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	April 2, 2007

Payer Source	Total Paid
Medicaid	$224.9M
Medicare	$0

Key Findings

REM COMMUNITY OPTIONS, INC. is effectively a single‑payer Medicaid provider at scale: lifetime Medicaid revenue is $224.9M while Medicare revenue is listed as none (no Medicare billing on file), indicating the organization’s operations and revenue are concentrated entirely in Medicaid-funded services rather than Medicare programs. This payer mix implies the provider’s financial performance and strategic exposure are tightly linked to state Medicaid policy and waiver program rules.

Revenue concentration is extreme within the Medicaid portfolio: the precomputed top three Medicaid codes account for 90.0% of the provider’s total Medicaid revenue, with S5125 alone representing 83.8% ($188.4M) of Medicaid revenue. That concentration signals heavy dependence on attendant care services for the organization’s overall revenue, making the business sensitive to changes in authorization, utilization, or rates for that single code.

The codes billed describe a community and waiver-focused service model: S5125 (attendant care services), T2021 (day habilitation, waiver), and T1002 (Rn services) are the top revenue generators, and the broader mix also includes G9002 (coordinated care fee), T1016 (case management), and T1005 (respite care). Together these codes indicate the provider delivers home- and community‑based supports, nursing and case management tied to waiver populations, and operates as a community/behavioral health agency emphasizing personal care and care coordination.

Competitive standing on the primary revenue driver is meaningful but not dominant statewide: S5125 ranks #8 of 43 providers in-state (83th percentile; typical, unremarkable volume for this code), which places the provider above many peers on attendant care volume but short of being a statewide leader. In other words, REM COMMUNITY OPTIONS is a sizable participant in attendant care delivery within West Virginia but not the top-tier leader for that specific code.

Several secondary codes show above‑typical statewide presence, highlighting a strength in care coordination and plan development: G9002 ranks #5 of 123 providers (97th percentile; notably above typical state volume), T1016 ranks #4 of 96 (97th percentile; notably above typical state volume), and T2024 ranks #2 of 45 (98th percentile; notably above typical state volume). These high percentiles and the accompanying “notably above typical” labels signal that the organization is a regional leader in coordinated‑care fees, case management, and service assessment/plan development, beyond its attendant care volumes.

Clinical staffing and nursing services are also material complements to attendant care: T1002 (Rn services) generated $5.4M (2.4% of Medicaid revenue) and ranks #9 of 151 providers in-state (95th percentile; typical, unremarkable volume for this code), while T1003 (Lpn/lvn services) produced $3.6M (1.6% of Medicaid revenue) and ranks #5 of 33 providers (88th percentile; typical, unremarkable volume). These data indicate substantive utilization of licensed nursing staff alongside personal care services, consistent with waiver populations requiring clinical oversight.

The provider’s tenure and scale reinforce its established role in the state Medicaid market: the NPI was enumerated on 2007-04-02 (~19 years ago), and cumulative Medicaid billing of $224.9M reflects a mature operation with long-standing participation in West Virginia’s waiver and community‑based service networks. That longevity, coupled with concentrated revenue streams, suggests institutional expertise delivering Medicaid waiver services but also an operational exposure to policy or reimbursement changes affecting those services.

Operational risk is concentrated by service line: because S5125, T2021, and T1002 together comprise 90.0% of Medicaid revenue, changes to coverage, utilization management, or payment rates for attendant care and related waiver services could have outsized financial impact on the organization. The absence of Medicare billing further reduces diversification of payer risk, meaning that state Medicaid program decisions are the primary driver of near‑term revenue variability for this provider.

Medicaid: Complete Services Breakdown

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S5125	Attendant care services; per 15 minutes	50,380	$3,740	$188.4M
T2021	Day habilitation, waiver; per 15 minutes	32,420	$270	$8.7M
T1002	Rn services, up to 15 minutes	17,880	$300	$5.4M
G9002	Coordinated care fee, maintenance rate	25,370	$210	$5.3M
T1016	Case management, each 15 minutes	27,350	$160	$4.4M
T1005	Respite care services, up to 15 minutes	5,070	$760	$3.9M
T1003	Lpn/lvn services, up to 15 minutes	15,760	$230	$3.6M
A0160	Non-emergency transportation: per mile - case worker or social worker	16,870	$140	$2.3M
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.	2,590	$350	$905.1K
A0120	Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems	7,270	$110	$770.1K

Showing 1–10 of 13

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. West Virginia Distribution

Rem Community Options, Inc. — 3 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — West Virginia

Full comparison — all codes billed, vs. West Virginia median

13 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5125	Attendant care services; per 15 minutes	8	40	14,820	$750	$30.5M
T2021	Day habilitation, waiver; per 15 minutes	9	60	6,490	$120	$2.2M
T1005	Respite care services, up to 15 minutes	7	30	2,980	$250	$1.5M
G9002	Coordinated care fee, maintenance rate	5	120	2,950	$150	$901.9K
T1003	Lpn/lvn services, up to 15 minutes	5	30	2,070	$90	$522.7K
T1016	Case management, each 15 minutes	4	100	2,790	$90	$496.2K
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.	41	140	790	$90	$469.7K
T2019	Habilitation, supported employment, waiver; per 15 minutes	3	10	420	$130	$445.4K
A0160	Non-emergency transportation: per mile - case worker or social worker	10	110	2,030	$50	$278.8K
T1002	Rn services, up to 15 minutes	9	150	1,980	$40	$232.6K

Showing 1–10 of 13

Rem Community Options, Inc. — Billing Profile & Reimbursement Data

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Rem Community Options, 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

Frequently Asked Questions

References