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

Why is the Medicaid comparison limited to 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. 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.

Grafton School, Inc. (NPI 1720159676)

Field	Value
Entity Type	Organization
Organization	Grafton School, Inc.
Address	120 Bellview Ave
City	Winchester
State	VA
ZIP	22601
Taxonomy	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
NPI Enumerated	November 13, 2006

Payer Source	Total Paid
Medicaid	$92M
Medicare	$0

Key Findings

This provider is effectively a single-payer Medicaid operation: lifetime Medicaid revenue is $92M and there is no Medicare billing on file. The absence of Medicare activity makes Medicaid the sole material payer driving the business and claims mix for GRAFTON SCHOOL, INC.

Revenue is highly concentrated: the top three Medicaid billing codes (H2022, H0019, T2021) account for 92.6% of the provider’s total Medicaid revenue. That concentration indicates the organization’s financial performance depends overwhelmingly on a small set of per-diem and habilitation service lines rather than a broad mix of outpatient or fee-for-service medical claims.

H2022 is the dominant revenue driver and a statewide outlier: the provider reported $55.4M on H2022 (60.3% of its Medicaid revenue) from 187.2K claims, and it ranks #1 of 136 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code). This signals a large-scale, high-volume operation focused on community-based wrap-around services delivered on a per-diem basis, and positions the provider as the primary in-state supplier for this specific service.

H0019 represents the second major revenue stream consistent with long-term residential care: the provider reported $22.3M on H0019 (24.3% of Medicaid revenue) across 50.8K claims and ranks #2 of 3 providers in-state (50th percentile; typical, unremarkable volume for this code). Given H0019’s definition as long-term residential (non-medical, non-acute) without room and board, this billing mix points to sustained residential placements and multi-week to multi-month stays as a core element of the business model.

T2021 billing further emphasizes habilitation programming: the provider reported $7.4M on T2021 (8.1% of Medicaid revenue) over 8.8K claims and ranks #13 of 108 providers in-state (89th percentile; typical, unremarkable volume for this code). T2021’s per-15-minute day habilitation structure indicates a substantial component of structured daytime habilitation services delivered under waiver arrangements complementing the residential continuum.

Ancillary therapy and group-service codes confirm a residential/rehabilitative delivery model rather than typical outpatient medical care: for example, 97150 generated $5M (5.5% of Medicaid revenue) and 97139 generated $1.4M (1.6% of Medicaid revenue), reflecting billed supervision of group therapeutic procedures and non-specific therapeutic services. The presence of these higher-paid group and supervised therapy codes supports an operational model with multi-patient therapy sessions and supervisory clinical staff embedded in the residential setting.

Competitive standing is mixed by code: GRAFTON SCHOOL is a statewide dominant provider for H2022 (top-ranked, extreme outlier) but a modest or typical participant on other codes — H0019 sits at a median rank among a very small competitor set (50th percentile, #2 of 3) and T2021 ranks toward the upper range but is described as typical for that code (89th percentile, #13 of 108). This pattern implies market leadership in community wrap-around services while remaining one of several providers for long-term residential and day habilitation services.

The provider has an established tenure in the Medicaid market, with an NPI enumerated on 2006-11-13 (~20 years ago). That longevity combined with a concentrated code mix suggests longstanding contractual relationships and operational specialization in residential and community-based intellectual/developmental disability services rather than a recent or diversified entrant into mixed medical billing streams.

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
H2022	Community-based wrap-around services, per diem	187,230	$300	$55.4M
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	50,810	$440	$22.3M
T2021	Day habilitation, waiver; per 15 minutes	8,830	$840	$7.4M
97150	In this procedure, the provider supervises and directs therapeutic procedures like exercise therapy for a group of patients.	4,440	$1,130	$5M
97139	Use 97139 to report therapeutic procedures that do not have a specific code.	4,520	$320	$1.4M
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	5,040	$50	$247.1K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	1,350	$40	$55.1K
97152	A technician, supervised by a physician or other qualified healthcare professional, provides supporting assessment of a patient’s destructive behavior and behavioral problems by interacting directly…	1,130	$20	$21.5K
99212	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a straightforward level of medical decision making,…	340	$40	$13.5K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	150	$90	$13.3K

Showing 1–10 of 12

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Virginia Distribution

Grafton School, Inc. — 1 of 12 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Virginia

Full comparison — all codes billed, vs. Virginia median

12 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H0019	Behavioral health; long‑term residential (non‑medical, non‑acute care in a residential treatment program where stay is typically longer than 30 days), without room and board, per diem	2	10	50,810	$380	$17.5M
H2022	Community-based wrap-around services, per diem	1	140	4,450	$1,150	$15.3M
97150	In this procedure, the provider supervises and directs therapeutic procedures like exercise therapy for a group of patients.	74	200	2,840	$320	$2.4M
T2021	Day habilitation, waiver; per 15 minutes	13	110	1,500	$340	$1.3M
97139	Use 97139 to report therapeutic procedures that do not have a specific code.	9	80	750	$300	$802.7K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	2,232	3,520	370	$70	$280.7K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	1,137	4,010	290	$50	$199.8K
97152	A technician, supervised by a physician or other qualified healthcare professional, provides supporting assessment of a patient’s destructive behavior and behavioral problems by interacting directly…	5	10	1,430	$110	$169.5K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	41	330	270	$40	$112.2K
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	92	170	770	$20	$87.1K

Showing 1–10 of 12

Related Providers

Other providers that share a Tax Identification Number (TIN) with Grafton School, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Grafton School Inc	VA	Psychiatric Residential Treatment Facility	$0	$33M

Nearby Providers

Other providers in the same ZIP code as Grafton School, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Winchester Medical Center	VA	General Acute Care Hospital	$0	$69.9M
Shenandoah Valley Community Residences, Inc.	VA	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$17.4M
Compassionate Home Care	VA	In Home Supportive Care Agency	$0	$14.5M
Nova Family Services, Inc.	VA	Intellectual and/or Developmental Disabilities Residential Treatment Facility	$0	$13.5M
Uncle Sam Transportation LLC	VA	Taxi	$0	$12M
National Counseling Group, Inc	VA	Mental Health Counselor	$0	$11.2M
Pediatrix Medical Group PC	VA	Neonatal-Perinatal Medicine Physician	$0	$10.8M
Winchester Medical Center	VA	Obstetrics & Gynecology Physician	$0	$10M
Gaurav Agarwal Dds, Msd, PLLC	VA	Dental Clinic/Center	$0	$8.9M
Valley Regional Enterprises, Inc	VA	Urgent Care Clinic/Center	$0	$8.6M

Grafton School, Inc. — Billing Profile & Reimbursement Data

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Grafton School, 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

Related Providers

Nearby Providers

Frequently Asked Questions

References