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

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

Option Care At Legacy Health LLC (NPI 1841350527)

Key Findings

Field	Value
Entity Type	Organization
Organization	Option Care At Legacy Health LLC
Address	16195 Sw 72nd Avenue
City	Portland
State	OR
ZIP	97224
Taxonomy	Home Infusion Therapy Pharmacy
NPI Enumerated	December 11, 2006

Payer Source	Total Paid
Medicaid	$18.6M
Medicare	$0

OPTION CARE AT LEGACY HEALTH LLC is effectively a single-payer Medicaid-focused supplier: there is no Medicare revenue on file and the provider reports $18.6M in total Medicaid revenue, indicating Medicaid drives its entire documented public-payer activity and should be the primary focus for contracting and utilization review. This concentration suggests limited exposure to Medicare payment rules and audit patterns but increased sensitivity to state Medicaid policy changes.

Revenue is highly concentrated in a small set of Medicaid codes: the top three codes (B4035, B4161, S9500) account for 40.8% of the provider’s Medicaid revenue, with B4035 contributing $4.5M (24.4%), B4161 $1.9M (10.1%), and S9500 $1.2M (6.3%). This concentration means monitoring utilization and pricing for those specific codes will capture a large share of the provider’s Medicaid financial footprint.

The code mix indicates a core business in home enteral and infusion services: large volumes and revenue for enteral feeding supply kits (B4035, 25.2K claims) and multiple enteral formula codes (B4161, B4153, B4152, B4149) alongside per-diem home infusion administrative codes (S9500, S9342) point to an integrated supply-plus-care-coordination model that dispenses formulas, supplies pumps, and bills per-diem services. The presence of both enteral and parenteral nutrition codes (B4185, S9366) shows operational capability across nutrition modalities rather than a narrow single-product focus.

On competitive standing within Oregon the provider is a top-ranked statewide participant for multiple high-revenue codes: it ranks #2 of 16 for B4035 (93th percentile, described as notably above typical state volume) and ranks #1 of 4 for S9500 (100th percentile, dataset labels this as typical, unremarkable volume). It also ranks #1 of 14 for B4152 (100th percentile; notably above typical state volume) and #1 of 2 for B4185 (100th percentile; labeled typical), which together indicate the provider is a major or leading supplier for several enteral/parenteral items in-state.

Several codes show high average paid per claim that amplify revenue despite smaller claim counts: B4161 averages $452 paid/claim, A4223 averages $442 paid/claim, and S9366 averages $688 paid/claim. These unit-price drivers — especially for specialty pediatric formulas and complex TPN per-diem services — materially contribute to the $18.6M Medicaid total and imply that price and utilization policy for these items will disproportionately affect revenue.

There are a number of single-provider or no-peer-comparison codes in the dataset that suggest unique or less-commoditized service lines: A4223 (rank #1 of 1; no state peer volume comparison available), S9366 (rank #1 of 1; no state peer volume comparison available), and B4224 (rank #1 of 1; no state peer volume comparison available). These items may reflect services or supply bundles that competitors rarely bill to Medicaid in this state, which could be operationally strategic or a focus area for deeper program-level review.

High-volume supply and pump-related items reinforce the provider’s role as a logistics/supply hub: large claim counts for pump-fed and syringe-fed supply kits (B4035 25.2K claims, B4034 8.1K claims) plus B9002 enteral nutrition infusion pumps (1.1K claims) show ongoing device and consumable distribution at scale, implying warehousing, delivery, and recurring billing capabilities are material parts of the business. That operational footprint aligns with the per-diem administrative codes (S9500, S9342) that package services and coordination around those supplies.

The provider’s NPI has been enumerated since 2006-12-11 (~20 years ago), indicating a long-standing presence in the market. This tenure, together with high rankings on several in-state codes, supports the view that the organization has established referral or contractual relationships in Oregon’s Medicaid ecosystem and that its billing patterns are likely stable over time absent major policy shifts.

Medicaid: Complete Services Breakdown

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

33 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
B4035	Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	25,210	$180	$4.5M
B4161	Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding…	4,120	$450	$1.9M
S9500	Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and…	4,530	$260	$1.2M
B4185	Parenteral nutrition solution, not otherwise specified, 10 grams lipids	7,950	$150	$1.2M
A4223	Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)	2,540	$440	$1.1M
B4153	Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral…	2,320	$440	$1M
99601	The provider visits the patient at home to provide an infusion or administer a specialty drug. Use this code for up to the first two hours of a visit.	8,800	$110	$933K
B4160	Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals,…	5,550	$160	$893.5K
B4152	Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include…	8,080	$110	$889.1K
B4149	Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral…	2,570	$340	$867.4K

Showing 1–10 of 33

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Oregon Distribution

Option Care At Legacy Health LLC — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Oregon

Full comparison — all codes billed, vs. Oregon median

33 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
A4223	Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)	1	10	2,540	$440	$1.1M
B4035	Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	2	20	1,990	$210	$1.1M
B4161	Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding…	2	10	580	$480	$1.1M
B4149	Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral…	2	10	1,050	$440	$992.1K
B4185	Parenteral nutrition solution, not otherwise specified, 10 grams lipids	1	10	5,970	$140	$836.2K
99601	The provider visits the patient at home to provide an infusion or administer a specialty drug. Use this code for up to the first two hours of a visit.	3	10	5,370	$100	$726.6K
S9366	Home infusion therapy, total parenteral nutrition (tpn); more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all…	1	10	990	$690	$683.1K
B4160	Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals,…	3	10	790	$150	$638.5K
B4153	Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral…	2	10	620	$450	$533.2K
S9379	Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and…	2	10	1,350	$170	$471.8K

Showing 1–10 of 33

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lincare Inc.	OR	Durable Medical Equipment & Medical Supplies	$0	$3.6M
Because It's There, LLC	OR	In Home Supportive Care Agency	$0	$2M
Credena Health LLC	OR	Community/Retail Pharmacy	$0	$2M
Cornerstone Chiropractic, LLC	OR	Chiropractor	$0	$1.6M
Robert Wood	OR	Oral and Maxillofacial Surgery (Dentist)	$0	$1.3M
Oregon Outpatient Surgery Center LLC	OR	Ambulatory Surgical Clinic/Center	$374.8K	$0
Jason Gilster	OR	Surgery Physician	$222.5K	$0
Matthew Mcclelland	OR	Dermatology Physician	$211.4K	$0
Firas Khoury	OR	Nephrology Physician	$181.4K	$0
Christopher Nanson	OR	Orthopaedic Surgery Physician	$154K	$0

Option Care At Legacy Health LLC — Billing Profile & Reimbursement Data

Sign up for Option Care At Legacy Health LLC — Billing Profile & Reimbursement Data policy alerts

Option Care At Legacy Health LLC — Billing Profile & Reimbursement Data

Sign up for Option Care At Legacy Health LLC — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References