Loading...
NPI 1861474272 · St. Johnsbury, VT · Land Ambulance
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Caledonia-essex Area Ambulance Service, Inc. is a land ambulance provider located in St. Johnsbury, Vermont. This profile covers 5 Medicare and 6 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | Caledonia-essex Area Ambulance Service, Inc. |
| Address | 1453 Hospital Drive |
| City | St. Johnsbury |
| State | VT |
| ZIP | 05819 |
| Taxonomy | Land Ambulance |
| NPI Enumerated | November 19, 2005 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $1.6M |
| Medicare | $406.4K |
CALEDONIA-ESSEX AREA AMBULANCE SERVICE, INC. is a long-tenured land ambulance provider, with its NPI enumerated since 2005-11-19 (~21 years ago), indicating sustained operation in ST. JOHNSBURY, VT and likely continued local emergency and non-emergency transport services over two decades. This tenure supports consistent relationships with both Medicare and Medicaid payers and suggests operational stability in the regional EMS market.
Medicaid revenue ($1.6M) substantially exceeds Medicare revenue ($406.4K), making this provider effectively Medicaid-weighted in scale; the provider bills meaningful volume to both payers but relies more heavily on Medicaid for total dollars, which has implications for reimbursement risk and payer contracting priorities.
Revenue concentration is high on both payers: the top three Medicare codes account for 88.6% of total Medicare revenue and the top three Medicaid codes account for 96.2% of total Medicaid revenue. This concentration indicates that a small set of ambulance services — specifically A0429, A0427, and A0425 — drive nearly all billed payments and should be the focus for utilization review, contracting, and operational capacity planning.
The provider’s Medicare mix is dominated by emergency transport codes: A0429 (BLS emergency), A0427 (ALS1 emergency), and A0425 (ground mileage) together represent the precomputed 88.6% Medicare concentration, showing the operation is primarily engaged in emergency response transports rather than a diversified set of ancillary ambulance services. That pattern suggests resource allocation toward emergency-capable crews and vehicles rather than a non-transport or specialty-supply focus.
On Medicaid, the same triplet of codes drives even more concentrated revenue (precomputed 96.2%): A0429 (BLS emergency), A0427 (ALS1 emergency), and A0425 (ground mileage). The Medicaid mix and high average paid/claim for A0429 ($190) and A0427 ($208) indicate frequent emergency transports billed to state programs and reinforce that emergency transport services are the core service line for this provider across payers.
Competitive standing is modest-to-strong but not dominant: for Medicare A0429 ranks #1361 of 7808 (83rd percentile) and A0425 ranks #1388 of 8934 (84th percentile), indicating above-typical national volume but not top-tier dominance; A0427 at the Medicare 60th percentile is around typical national participation. For Medicaid, the provider ranks in the top deciles in-state for key codes (A0429 and A0427 both at the 82–85th percentile and A0425 at the 88th percentile), positioning it as one of the larger in-state ambulances for emergency transport and mileage revenue without being a statewide monopoly.
Code-level operational implications: high claim counts and material revenue for A0425 (ground mileage) on both Medicare (15K claims, $120K) and Medicaid (7.2K claims, $419.3K) show that mileage billing is a significant component of transport economics for this provider and will materially affect revenue per trip and reimbursement sensitivity to distance rules. Similarly, the sizable counts and revenues for A0429 and A0427 across both payers reflect repeated use of both BLS and ALS emergency teams, implying mixed staffing and equipment needs to meet emergency-response demand.
Statistical standing language from the ranking data supports a conclusion of typical, unremarkable national volumes for Medicare top codes (all listed as "typical, unremarkable volume for this code") and typical, unremarkable in-state volume for Medicaid codes as well; none of the reported top codes are flagged as extreme outliers, so the provider’s billing patterns appear consistent with peers rather than atypical in a statistical sense.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 410 | $330 | $137.5K |
| A0425 | Ground mileage, per statute mile | 15,010 | $10 | $120K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 250 | $400 | $97.9K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 150 | $210 | $32.6K |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) | 50 | $260 | $13K |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
6 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 3,530 | $190 | $669.9K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 2,290 | $210 | $477.2K |
| A0425 | Ground mileage, per statute mile | 7,230 | $60 | $419.3K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 490 | $100 | $49.1K |
| A0998 | Ambulance response and treatment, no transport | 50 | $230 | $11.9K |
| A0394 | Als specialized service disposable supplies; iv drug therapy | 30 | $30 | $890 |
How this provider's Medicaid billing volume and revenue compare to other Vermont providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Vermont median
6 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) | 8 | 40 | 580 | $190 | $370.2K |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) | 8 | 50 | 590 | $220 | $265.7K |
| A0425 | Ground mileage, per statute mile | 8 | 60 | 1,570 | $50 | $160.5K |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) | 10 | 20 | 690 | $100 | $151.9K |
| A0998 | Ambulance response and treatment, no transport | 4 | 10 | 40 | $160 | $23.6K |
| A0394 | Als specialized service disposable supplies; iv drug therapy | 12 | 20 | 120 | $30 | $11.2K |
Other providers in the same ZIP code as Caledonia-essex Area Ambulance Service, Inc., ranked by combined Medicare and Medicaid revenue.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.