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

Why is the Medicaid comparison limited to South Carolina 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. South Carolina (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.

The Charles Lea Center Inc. (NPI 1881034437)

Field	Value
Entity Type	Organization
Organization	The Charles Lea Center Inc.
Address	195 Burdette St
City	Spartanburg
State	SC
ZIP	29307
Taxonomy	In Home Supportive Care Agency
NPI Enumerated	June 27, 2013

Payer Source	Total Paid
Medicaid	$70.3M
Medicare	$0

Key Findings

THE CHARLES LEA CENTER INC. is effectively a Medicaid-centric provider with no Medicare billing on file and $70.3M in reported lifetime Medicaid revenue, indicating a single-payer operational footprint concentrated on state Medicaid programs. Its NPI was enumerated on 2013-06-27 (~13 years ago), so the organization has been active long enough to establish sustained relationships with Medicaid managed-care or state waiver programs.

Revenue concentration is very high: the precomputed top three Medicaid codes (T2016, T2020, H2016) together account for 86.8% of the provider's total Medicaid revenue. In particular, T2016 alone represents $53.2M or 75.6% of Medicaid revenue, which signals dependency on a single service line and exposure to rate or policy changes affecting that code.

The code mix and descriptions identify the provider’s operational focus: large per-diem payments for T2016 (Habilitation, residential, waiver) and T2020 (Day habilitation, waiver) alongside per-diem community supports such as H2016 (Comprehensive community support services) indicate the organization primarily runs residential habilitation programs, day habilitation, and community-based support services rather than outpatient medical care. This pattern is consistent with an In Home Supportive Care Agency that manages long-stay residential and day-program services, implying substantial facility, staffing, and waiver-administration infrastructure.

Competitive standing in-state is strong for several core services. T2016 ranks #3 of 52 providers in South Carolina (96th percentile), and T2020 ranks #4 of 40 (92th percentile), showing materially above-typical state volume for the provider’s dominant habilitation offerings; H2016 also ranks highly at #2 of 15 providers (93th percentile), reinforcing its role as a major statewide participant in residential and community habilitation services.

There are notable statistical outliers and unique positionings within the provider’s service mix: T2017 (Habilitation, residential, waiver; 15 minutes) ranks #1 of 8 providers at the 100th percentile, described as notably above typical state volume, while T2033 (Residential care, nos, waiver) is listed as #1 of 1 providers with no peer-volume comparison available, suggesting the provider offers at least one residential service type that appears uncommon among state peers. These flags imply both strength in selected niche services and limited direct competition for certain residential codes.

Despite heavy concentration in per-diem habilitation codes, the provider offers a broader array of Medicaid services at lower revenue levels—examples include H2026 (ongoing employment supports) with $2.1M (3.0%), T1017 (targeted case management) with $1.4M (2.1%), and S9123 (nursing care in the home) with $303.3K (0.4%). These secondary revenue streams indicate supplemental service lines that support habilitation and community integration but do not materially diversify the revenue base away from residential/day habilitation.

The revenue profile presents operational and financial risk considerations: with $53.2M tied to T2016 (75.6% of Medicaid revenue) and the top three codes totaling 86.8%, payers or programmatic shifts affecting residential habilitation per diems could meaningfully impact the provider’s topline. Analysts should monitor policy changes to waiver rates, per-diem reimbursement, and state-level program design that target T2016/T2020/H2016 services.

Operational implications for contracting and network strategy are clear: as a high-volume, high-percentile provider for residential and day habilitation in South Carolina, THE CHARLES LEA CENTER is positioned as a major in-state habilitation vendor and would be a strategic target for Medicaid managed-care networks seeking capacity in residential waiver slots and day habilitation programs. However, its lack of Medicare billing means it is not positioned for dual-eligible or Medicare-dependent revenue streams, so payer negotiations and risk arrangements should be pursued with a Medicaid-first focus.

Medicaid: Complete Services Breakdown

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

13 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2016	Habilitation, residential, waiver; per diem	219,650	$240	$53.2M
T2020	Day habilitation, waiver; per diem	54,670	$80	$4.3M
H2016	Comprehensive community support services, per diem	44,650	$80	$3.6M
H2026	Ongoing support to maintain employment, per diem	27,710	$80	$2.1M
T2033	Residential care, not otherwise specified (nos), waiver; per diem	8,600	$250	$2.1M
T2014	Habilitation, prevocational, waiver; per diem	20,120	$80	$1.5M
T1017	Targeted case management, each 15 minutes	22,600	$60	$1.4M
T2017	Habilitation, residential, waiver; 15 minutes	10,600	$110	$1.2M
H2025	Ongoing support to maintain employment, per 15 minutes	5,550	$90	$483.2K
S9123	Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used)	1,350	$230	$303.3K

Showing 1–10 of 13

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. South Carolina Distribution

The Charles Lea Center Inc. — 2 of 13 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — South Carolina

Full comparison — all codes billed, vs. South Carolina median

13 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2016	Habilitation, residential, waiver; per diem	3	50	42,240	$250	$15.4M
T2033	Residential care, not otherwise specified (nos), waiver; per diem	1	10	8,600	$250	$2.1M
T2014	Habilitation, prevocational, waiver; per diem	16	30	17,930	$70	$1.9M
T2020	Day habilitation, waiver; per diem	4	40	18,120	$70	$1.8M
T1017	Targeted case management, each 15 minutes	11	60	7,610	$50	$1.2M
H2016	Comprehensive community support services, per diem	2	20	8,760	$60	$1.1M
H2026	Ongoing support to maintain employment, per diem	6	30	10,980	$70	$939.8K
T1027	Family training and counseling for child development, per 15 minutes	69	80	3,560	$100	$857.8K
S9123	Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used)	2	10	2,590	$320	$822K
T1016	Case management, each 15 minutes	84	100	4,210	$50	$614.8K

Showing 1–10 of 13

Nearby Providers

Other providers in the same ZIP code as The Charles Lea Center Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Spartanburg School District 7	SC	Local Education Agency (LEA)	$0	$9.2M
Elite Home Care	SC	In Home Supportive Care Agency	$0	$6.9M
Spartanburg Medical Center	SC	Urgent Care Clinic/Center	$0	$4.2M
Spartanburg Medical Center	SC	Obstetrics & Gynecology Physician	$0	$3.3M
Circle Of Angels Home Health Care	SC	Home Health Agency	$0	$3M
Spartanburg Pediatric Dentistry	SC	Pediatric Dentistry	$0	$2.7M
Mary Black Health System LLC	SC	General Acute Care Hospital	$0	$2.3M
Allergy Partners, PLLC	SC	Allergy & Immunology Physician	$0	$2.2M
Lincare Inc.	SC	Durable Medical Equipment & Medical Supplies	$0	$2M
The Forrester Center For Behavioral Health, Inc.	SC	Substance Use Disorder Rehabilitation Clinic/Center	$0	$1.9M

The Charles Lea Center Inc. — Billing Profile & Reimbursement Data

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The Charles Lea Center Inc. — 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