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

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

Waukesha County (NPI 1740403146)

Field	Value
Entity Type	Organization
Organization	Waukesha County
Address	514 Riverview Ave
City	Waukesha
State	WI
ZIP	53188
Taxonomy	Case Management Agency
NPI Enumerated	April 11, 2007

Payer Source	Total Paid
Medicaid	$18M
Medicare	$0

Key Findings

This provider has no Medicare billing on file and reports $18M in lifetime Medicaid revenue, making its commercial/payer footprint effectively single-payer (Medicaid)-focused in the available data. Analysts should treat Medicaid as the primary and near-exclusive revenue source when evaluating market exposure and contracting relationships.

The provider is listed under the Case Management Agency taxonomy and its claims mix is overwhelmingly driven by T1016 (Case management, each 15 minutes). T1016 accounts for $17.3M of revenue (96.2% of the provider's Medicaid revenue), indicating an operational model centered on labor-intensive case management and care coordination services billed in 15-minute increments.

Revenue concentration is extreme: the top three Medicaid codes together account for 99.7% of this provider's Medicaid revenue, with T1016 alone representing the vast majority. This level of concentration signals material dependence on a small set of service lines and exposure to payment-rate or policy changes affecting those codes.

Competitive standing for the primary service is dominant at the state level: T1016 billing ranks #3 of 224 providers in-state (99th percentile; extreme outlier), meaning this entity operates far above typical state volume for that code and is a major provider of case management services within Wisconsin. That rank suggests meaningful scale and influence in the state market for T1016-related services.

The two other top Medicaid codes are A9999 ($372K, 2.1% of Medicaid revenue) and T2028 ($267.2K, 1.5% of Medicaid revenue); both rank in the upper deciles in-state (#7 of 56 at the 89th percentile and #7 of 42 at the 85th percentile, respectively) and are characterized as typical, unremarkable volumes. These secondary codes provide modest revenue diversification but do not materially offset concentration around T1016.

S5161 (Emergency response system; service fee, per month) appears with 2.8K claims and $44.6K revenue (0.2% of Medicaid revenue) and ranks #1 of 17 in-state (100th percentile; notably above typical state volume), indicating the provider also offers emergency response system services at a small scale. S5162 is negligible (18 claims, $1.7K revenue, 0.0% of Medicaid revenue) and ranks #2 of 2 in-state (labeled typical, unremarkable), reinforcing that non-case-management services are ancillary.

The provider's NPI was enumerated on 2007-04-11 (~19 years ago), indicating long tenure in the market and likely established operational and payer relationships with Medicaid programs and managed care plans. This longevity supports the interpretation that the observed high-volume T1016 billing represents an enduring business model rather than a short-term fluctuation.

From a risk and strategic perspective, the combination of single-payer concentration (no Medicare revenue and $18M Medicaid revenue) and extreme reliance on one dominant code (T1016 at 96.2%) creates vulnerability to reimbursement, authorization, or policy changes affecting case management billing. For payers and competitors, this pattern suggests the provider has operational scale in case management but limited diversification, which is an important consideration for contracting, utilization management, and competitive benchmarking.

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
T1016	Case management, each 15 minutes	283,650	$60	$17.3M
A9999	Miscellaneous dme supply or accessory, not otherwise specified	3,020	$120	$372K
T2028	Specialized supply, not otherwise specified, waiver	1,310	$200	$267.2K
S5161	Emergency response system; service fee, per month (excludes installation and testing)	2,790	$20	$44.6K
S5162	Emergency response system; purchase only	20	$90	$1.7K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Wisconsin Distribution

Waukesha County — 2 of 5 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Wisconsin

Full comparison — all codes billed, vs. Wisconsin median

5 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1016	Case management, each 15 minutes	3	220	7,110	$70	$1.7M
T2028	Specialized supply, not otherwise specified, waiver	7	40	340	$210	$188.6K
A9999	Miscellaneous dme supply or accessory, not otherwise specified	7	60	460	$170	$177.3K
S5161	Emergency response system; service fee, per month (excludes installation and testing)	1	20	180	$30	$23.2K
S5162	Emergency response system; purchase only	2	10	50	$60	$2.8K

Nearby Providers

Other providers in the same ZIP code as Waukesha County, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prohealth Waukesha Memorial Hospital, Inc.	WI	General Acute Care Hospital	$0	$21.5M
Waukesha County	WI	Community/Behavioral Health Agency	$0	$15M
Hometown Hospice & Homecare Inc	WI	Community Based Hospice Care Agency	$0	$12.1M
Prohealth Medical Group Inc.	WI	Pediatrics Physician	$0	$8.2M
Neurotech, LLC	WI	Physiological Laboratory	$145.8K	$7.8M
Commonheart, Inc.	WI	Community Based Hospice Care Agency	$0	$7.2M
Kinex Medical Company LLC	WI	Durable Medical Equipment & Medical Supplies	$0	$7.1M
Waukesha County	WI	Community/Behavioral Health Agency	$0	$3.2M
Oxygen One, Inc.	WI	Oxygen Equipment & Supplies (DME)	$0	$2.8M
Waukesha County Community Dental Clinic, Inc.	WI	Dental Clinic/Center	$0	$2.3M

Waukesha County — Billing Profile & Reimbursement Data

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Waukesha County — 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