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

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

State Of Missouri (NPI 1831259704)

Field	Value
Entity Type	Organization
Organization	State Of Missouri
Address	3600 E Newman Rd
City	Joplin
State	MO
ZIP	64802
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	December 11, 2006

Payer Source	Total Paid
Medicaid	$65.1M
Medicare	$0

Key Findings

This entity has no Medicare billing on file and is effectively a single-payer Medicaid operator for the dataset provided; Medicaid revenue totals $65.1M while Medicare revenue is listed as none, indicating all reported federal billing for this NPI flows through Medicaid programs. The lack of Medicare activity simplifies payer analysis but means Medicare-based benchmarks are not applicable to this provider.

Revenue is highly concentrated in a single Medicaid service: T1019 accounts for $63.1M, or 96.9% of the provider’s total Medicaid revenue. That concentration indicates the organization’s business model is overwhelmingly focused on personal care services billed in 15-minute units under T1019 rather than a diversified portfolio of Medicaid service lines.

Operationally, the top code mix (T1019 and T2029) suggests this provider operates primarily as a Developmentally Disabled Services Day Training Agency delivering hands-on personal care and support services per individualized plans, with a secondary role supplying waiver-authorized specialized medical equipment (T2029). The dominant share of T1019 revenue implies day-to-day service delivery and direct caregiver time are the core of its operations, while T2029 represents a minor equipment/waiver support function.

On competitive standing within Missouri for its leading code, the provider ranks #46 out of 1,332 for T1019 and sits in the 97th percentile, which the data labels as "notably above typical state volume for this code." That rank places the provider among the highest-volume in-state suppliers of T1019, making it a major regional participant for personal care services under Medicaid.

The secondary code, T2029, contributes $2M or 3.1% of Medicaid revenue and the provider ranks #6 of 41 in-state (88th percentile) for that code. The state ranking and percentile label indicate a solid, though much smaller, presence in waiver-related specialized medical equipment; this is a meaningful but secondary revenue stream compared with personal care services.

The NPI was enumerated on 2006-12-11 (approximately 20 years ago), indicating long tenure in the Medicaid market. That duration supports the interpretation that the organization is an established service provider within its community and likely has longstanding operational processes for delivering T1019 services.

Given that the top 3 Medicaid codes account for 100.0% of Medicaid revenue and that T1019 alone is 96.9% of the total, the provider’s financial performance is highly dependent on sustained authorization and payment for that single service code. This concentration creates operational sensitivity to policy, reimbursement, or utilization changes affecting T1019.

From a payer/contracting perspective, this provider should be evaluated primarily on capacity, quality, and compliance related to personal care services (T1019) because that code drives virtually all Medicaid revenue. Any network or rate negotiations, audits, or program changes will disproportionately impact the organization’s financial health due to the extreme concentration in one service line.

Medicaid: Complete Services Breakdown

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

2 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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…	352,320	$180	$63.1M
T2029	Specialized medical equipment, not otherwise specified, waiver	10,710	$190	$2M

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Missouri Distribution

State Of Missouri — 1 of 2 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Missouri

Full comparison — all codes billed, vs. Missouri median

2 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	46	1,330	6,550	$80	$4.6M
T2029	Specialized medical equipment, not otherwise specified, waiver	6	40	1,720	$200	$1.4M

State Of Missouri — Billing Profile & Reimbursement Data

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State Of Missouri — 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