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

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

Acumen Fiscal Agent LLC (NPI 1720145378)

Field	Value
Entity Type	Organization
Organization	Acumen Fiscal Agent LLC
Address	5416 E Baseline Rd Ste 200
City	Mesa
State	AZ
ZIP	85206
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	January 2, 2007

Payer Source	Total Paid
Medicaid	$1.1B
Medicare	$0

Key Findings

ACUMEN FISCAL AGENT LLC is effectively a single-payer Medicaid operator at scale: it reports no Medicare revenue on file and $1.06B in lifetime Medicaid revenue, making Medicaid the sole material payer for this entity. The provider has a long NPI tenure (enumerated 2007-01-02, ~19 years ago), indicating an established presence in its market.

Revenue is highly concentrated in a few service lines: the precomputed top 3 Medicaid codes account for 74.6% of this provider's total Medicaid revenue, and a single code, S5125, represents $678.3M (64.1%) of Medicaid revenue alone. This level of concentration means changes to reimbursement or utilization for S5125 would disproportionately affect the provider's overall Medicaid revenue.

The code mix and taxonomy (Community/Behavioral Health Agency) show a clear operational focus on home- and community-based services and waiver programs: S5125 (attendant care services; per 15 minutes), T2025 (waiver services, NOS), and T2013 (habilitation, educational, waiver; per hour) are the top revenue drivers, which is consistent with large-scale attendant/personal care and habilitation delivery rather than facility-based acute care. Supplemental codes in the top 25 (T2016, S5150, T1019, T2033, H2015, H2025) further indicate a portfolio that includes residential habilitation, respite, community supports, and employment-related supports.

ACUMEN is a dominant statewide player on multiple Medicaid service lines: it ranks #1 of 223 providers in-state for S5125 and is labeled an "extreme outlier" on that code, and similarly ranks #1 for numerous waiver and HCBS codes (many listed as #1 of 1 providers in-state). Several of its top codes (e.g., T2016 at #4 of 27 and T2017 at #15 of 63) fall into more typical statewide volume percentiles, showing that dominance is concentrated in specific service lines rather than across every Medicaid code.

The provider appears to be the exclusive or near-exclusive in-state reporter for a number of waiver-related codes: multiple top-25 entries are listed as "#1 of 1 providers in-state (0th percentile; no state peer volume comparison available)" which suggests ACUMEN either holds unique contracts, operates exclusive service arrangements, or concentrates billing for certain specialized waiver services in its state. This pattern merits attention when assessing competitive dynamics for those service lines.

Operational scale is evident in high claim volumes and short-interval billing patterns: S5125 has 6.9M claims, T2040 has 671.3K claims, and T1019 has 330.4K claims, reflecting delivery models that bill per 15-minute or per-unit intervals common to personal/attendant care and financial-management services. Average paid/claim figures vary widely (e.g., $99 for S5125 vs. $22 for T2040), highlighting a mix of higher-paid direct care and lower-paid administrative or management items within the same Medicaid portfolio.

Despite the concentration in a handful of codes, the breadth of codes billed (respite S5150 and T1005, residential T2033, habilitation T2013/T2016/T2017, day habilitation T2021, employment H2025, wrap-around H2021/H2015, and specialized supply T2028) indicates ACUMEN operates a broad HCBS and waiver services suite rather than a single narrow service. This breadth can support cross-service coordination opportunities but does not negate the revenue concentration already noted in S5125 and the top three codes overall.

From a payer/contracting perspective, ACUMEN's profile signals both market power and concentration risk: it is a statewide leader or sole reporter on many waiver and attendant-care codes (including several labeled "extreme outlier" or "notably above typical state volume"), which could support negotiations on volume-based arrangements, but its dependence on a few high-revenue codes (top 3 = 74.6%) creates vulnerability to policy, audit, or reimbursement shifts affecting those codes.

Medicaid: Complete Services Breakdown

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

47 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
S5125	Attendant care services; per 15 minutes	6,851,510	$100	$678.3M
T2025	Waiver services; not otherwise specified (nos)	317,110	$200	$63.1M
T2013	Habilitation, educational, waiver; per hour	286,460	$170	$47.6M
T2016	Habilitation, residential, waiver; per diem	361,160	$120	$44.1M
S5150	Unskilled respite care, not hospice; per 15 minutes	246,620	$100	$23.7M
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…	330,440	$70	$23.5M
T2012	Habilitation, educational; waiver, per diem	123,510	$190	$23.1M
T2028	Specialized supply, not otherwise specified, waiver	145,680	$160	$22.9M
T2033	Residential care, not otherwise specified (nos), waiver; per diem	136,180	$160	$21.7M
H2021	Community-based wrap-around services, per 15 minutes	186,630	$100	$18.8M

Showing 1–10 of 47

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Arizona Distribution

Acumen Fiscal Agent LLC — 8 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Arizona

Full comparison — all codes billed, vs. Arizona median

47 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2025	Waiver services; not otherwise specified (nos)	1	10	317,110	$200	$63M
T2016	Habilitation, residential, waiver; per diem	4	30	76,220	$310	$52.4M
T2013	Habilitation, educational, waiver; per hour	1	10	286,460	$170	$47.6M
T2012	Habilitation, educational; waiver, per diem	1	10	123,510	$190	$23.1M
T2028	Specialized supply, not otherwise specified, waiver	1	10	145,680	$160	$22.8M
S5125	Attendant care services; per 15 minutes	1	220	24,500	$120	$15.5M
T1005	Respite care services, up to 15 minutes	1	10	167,450	$70	$12.3M
T2017	Habilitation, residential, waiver; 15 minutes	15	60	32,290	$90	$9M
99509	A home health provider, such as a registered nurse, or a non nursing practitioner, visits a patient to provide help with activities of daily living, or ADLs, and self care.	1	10	63,230	$130	$8.5M
M0355	N/A	1	10	41,240	$170	$7.2M

Showing 1–10 of 47

Nearby Providers

Other providers in the same ZIP code as Acumen Fiscal Agent LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Affinity Family Care, LLC.	AZ	Home Health Agency	$0	$63.8M
Residents At The Heights, LLC	AZ	Substance Abuse Rehabilitation Facility	$0	$33.2M
Banner Baywood Medical Center	AZ	General Acute Care Hospital	$0	$29.6M
A Brighter Avenue LLC	AZ	Speech-Language Pathologist	$0	$28.6M
Emergency Physicians Southwest, PC	AZ	Emergency Medicine Physician	$0	$27M
Health Care Alternatives, Inc.	AZ	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$26.1M
Christian3 Mega Clinic LLC	AZ	Substance Use Disorder Rehabilitation Clinic/Center	$0	$22.3M
Horizon Pediatric Therapy, Inc.	AZ	Music Therapist	$0	$17.9M
Zarephath Inc.	AZ	Community/Behavioral Health Agency	$0	$17M
Endeavor Hcbs LLC	AZ	Child Intellectual and/or Developmental Disabilities Respite Care	$0	$15.9M

Acumen Fiscal Agent LLC — Billing Profile & Reimbursement Data

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Acumen Fiscal Agent 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