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.

Agrace Hospicecare, Incorporated (NPI 1861503534)

Field	Value
Entity Type	Organization
Organization	Agrace Hospicecare, Incorporated
Address	5395 E Cheryl Pkwy
City	Fitchburg
State	WI
ZIP	53711
Taxonomy	Community Based Hospice Care Agency
NPI Enumerated	August 31, 2006

Payer Source	Total Paid
Medicaid	$35.1M
Medicare	$0

Key Findings

AGRACE HOSPICECARE, INCORPORATED reports no Medicare billing on file and $35.1M in lifetime Medicaid revenue, making its publicly visible federal billing presence effectively single‑payer and highly concentrated in Medicaid. Analysts should treat Medicaid as the primary — and for available data the sole — source of fee‑for‑service revenue when profiling this entity or modeling exposure.

The provider’s service mix, as reflected in the top-paid Medicaid codes, is classically hospice‑oriented: T2046 (Hospice long term care, room and board only; per diem) and T2042 (Hospice routine home care; per diem) together dominate revenue, signaling an operational emphasis on hospice care delivered primarily in long‑term‑care settings with a secondary home‑care component. These code descriptions indicate core operations are facility‑based hospice room-and-board services supplemented by routine home hospice visits.

Revenue concentration is extreme: the precomputed top 3 Medicaid codes account for 100.0% of this provider’s total Medicaid revenue, with T2046 representing $30.5M (87.0%) and T2042 $4.5M (12.9%); the third top code, G0299, contributes only $6.4K (0.0%). This concentration means payer negotiations, utilization management, or reimbursement changes affecting T2046 or T2042 would materially affect the provider’s entire Medicaid revenue stream.

AGRACE is a dominant statewide participant on the LTC hospice per‑diem metric: T2046 ranks #1 of 54 providers in-state (100th percentile; extreme outlier, far above typical state volume for this code), indicating a market position well above typical peers for room‑and‑board hospice billing in Wisconsin. That ranking suggests strong operational scale or a focused contract footprint in skilled nursing/long‑term care facilities relative to other in‑state hospices.

By contrast, T2042 (Hospice routine home care) ranks #3 of 7 providers in-state (67th percentile), a middling position among the much smaller set of providers billing that code, indicating the provider is an active but not dominant home‑care hospice biller. G0299 (direct RN skilled nursing services in hospice) ranks #3 of 46 (96th percentile; notably above typical) but generates only $6.4K in revenue, implying high relative rank does not translate into material revenue impact for this code.

There are notable claim‑payment patterns that merit attention: several codes show substantial claim counts but $0 avg paid/claim (for example G0156 has 1.5K claims with $0 avg paid and Q5003 has 111 claims with $0 avg paid). These patterns may reflect state payment policies, bundled or facility‑paid arrangements, or administrative billing practices rather than revenue generation; analysts should reconcile claim volumes with paid amounts when assessing operational throughput versus realized Medicaid revenue.

The provider’s NPI was enumerated on 2006-08-31 (~20 years ago), indicating a long tenure in the market that may support established referral relationships with long‑term care facilities and Medicaid programs. That longevity, combined with the outsized T2046 volume, suggests AGRACE’s business model has been oriented toward LTC hospice services for an extended period.

From a payer perspective, risk and utilization oversight should prioritize T2046 given it accounts for $30.5M and 87.0% of Medicaid revenue; contract and utilization levers targeted at LTC hospice per‑diem payments will have the largest impact on cost and access for this provider, while routine home care (T2042) is a secondary but materially smaller lever at $4.5M (12.9%).

Medicaid: Complete Services Breakdown

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

9 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2046	Hospice long term care, room and board only; per diem	192,080	$160	$30.5M
T2042	Hospice routine home care; per diem	12,400	$370	$4.5M
G0299	Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, each 15 minutes	3,190	$1	$6.4K
G0155	Services of clinical social worker in home health or hospice settings, each 15 minutes	790	$1	$790
G0156	Services of home health/hospice aide in home health or hospice settings, each 15 minutes	1,480	$0	$0
G0300	Direct skilled nursing services of a licensed practical nurse (LPN) in the home health or hospice setting, each 15 minutes	80	$0	$0
Q5001	Hospice or home health care provided in patient's home/residence	80	$0	$0
Q5002	Hospice or home health care provided in assisted living facility	120	$0	$0
Q5003	Hospice care provided in nursing long term care facility (ltc) or non-skilled nursing facility (nf)	110	$0	$0

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

Agrace Hospicecare, Incorporated — 3 of 4 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

9 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2046	Hospice long term care, room and board only; per diem	1	50	2,350	$310	$3.9M
T2042	Hospice routine home care; per diem	3	10	10,620	$190	$1.7M
G0299	Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, each 15 minutes	3	50	170	$1	$1.3K
G0155	Services of clinical social worker in home health or hospice settings, each 15 minutes	2	40	50	$1	$280
Q5001	Hospice or home health care provided in patient's home/residence	2	10	30	$1	$10
G0156	Services of home health/hospice aide in home health or hospice settings, each 15 minutes	1	40	240	$0	$0
G0300	Direct skilled nursing services of a licensed practical nurse (LPN) in the home health or hospice setting, each 15 minutes	5	20	60	$0	$0
Q5002	Hospice or home health care provided in assisted living facility	3	30	20	$0	$0
Q5003	Hospice care provided in nursing long term care facility (ltc) or non-skilled nursing facility (nf)	1	20	30	$0	$0

Nearby Providers

Other providers in the same ZIP code as Agrace Hospicecare, Incorporated, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Home Care United, Inc.	WI	Durable Medical Equipment & Medical Supplies	$0	$2.5M
Hhu Xtra Care Inc	WI	Home Infusion Therapy Pharmacy	$0	$2.3M
Journey Mental Health Center, Inc.	WI	Case Management Agency	$0	$2.1M
Allison Dowd	WI	Pediatric Dentistry	$0	$1.9M
Eric Teduits	WI	Pediatric Dentistry	$0	$1.8M
Christopher Lynch	WI	Physical Medicine & Rehabilitation Physician	$237.1K	$0
Walgreen Co	WI	Pharmacy	$190.1K	$12.6K
Walgreen Co	WI	Pharmacy	$173.6K	$25.2K
Mark Huth	WI	Family Medicine Physician	$109.2K	$83.9K
Hy-vee Inc	WI	Community/Retail Pharmacy	$151.7K	$2K

Agrace Hospicecare, Incorporated — Billing Profile & Reimbursement Data

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Agrace Hospicecare, Incorporated — 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