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.

Option Care Home Care Inc (NPI 1972534154)

Option Care Home Care Inc is a pharmacy provider located in Wauwatosa, Wisconsin. This profile covers 0 Medicare and 34 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Option Care Home Care Inc
Address	10101 W Innovation Dr Ste 200
City	Wauwatosa
State	WI
ZIP	53226
Taxonomy	Pharmacy
NPI Enumerated	July 5, 2006

Payer Source	Total Paid
Medicaid	$12.5M
Medicare	$0

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

34 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	26,010	$130	$3.4M
B4149	Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral…	9,080	$260	$2.3M
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…	3,980	$330	$1.3M
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,…	8,730	$120	$1.1M
B4088	Gastrostomy/jejunostomy tube, low-profile, any material, any type, each	13,710	$60	$836.6K
B4150	Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100…	5,450	$130	$718.7K
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…	7,010	$80	$588.4K
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…	1,250	$380	$478.6K
T1999	Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks"	24,990	$10	$324.9K
B4154	Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or…	1,480	$200	$301.9K

Showing 1–10 of 34

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

Option Care Home Care Inc — 14 of 25 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

34 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
B4149	Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral…	1	10	2,610	$310	$912.3K
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…	1	10	2,300	$370	$781.6K
B4035	Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	1	20	530	$140	$543.1K
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,…	1	10	1,870	$150	$413.2K
B4154	Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or…	2	10	1,150	$240	$302.8K
B4088	Gastrostomy/jejunostomy tube, low-profile, any material, any type, each	1	10	2,720	$60	$291.8K
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…	1	10	770	$290	$227.3K
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…	1	10	270	$400	$182.8K
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…	1	10	350	$110	$177.7K
B4150	Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100…	1	20	340	$120	$159.9K

Showing 1–10 of 34

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Vgm Group, Inc.	IA	Durable Medical Equipment & Medical Supplies	$0	$54.4M
Trinity Homecare LLC	NY	Home Infusion Therapy Pharmacy	$0	$46.8M
Option Care Enterprises, Inc.	IL	Home Infusion Therapy Pharmacy	$0	$45.6M
Option Care Enterprises Inc	KY	Pharmacy	$0	$39.1M
Option Care Enterprises Inc	MA	Home Infusion Therapy Pharmacy	$0	$37M
Option Care Enterprises, Inc.	FL	Home Infusion Therapy Pharmacy	$0	$29.3M
Option Care Enterprises, Inc.	OH	Home Infusion Therapy Pharmacy	$0	$18.9M
Option Care Enterprises, Inc.	WA	Home Infusion Therapy Pharmacy	$0	$18.9M
Option Care Enterprises, Inc.	TX	Home Infusion Therapy Pharmacy	$0	$13.8M
Option Care Enterprises, Inc	CT	Home Infusion Therapy Pharmacy	$0	$13.3M

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Children's Hospital Of Wisconsin, Inc.	WI	Children's Hospital	$0	$262.3M
Froedtert Memorial Lutheran Hospital, Inc.	WI	General Acute Care Hospital	$0	$157.8M
The Medical College Of Wisconsin, Inc.	WI	Internal Medicine Physician	$17.8K	$74.8M
Emergency Medicine Specialists, S.c.	WI	Emergency Medicine Physician	$0	$35.3M
Wisconsin Diagnostic Laboratories LLC	WI	Clinical Medical Laboratory	$2.3M	$22.7M
Childrens Hospital Of Wisconsin, Inc.	WI	Pediatrics Physician	$0	$19M
Children's Hospital And Health System, Inc.	WI	Urgent Care Clinic/Center	$0	$17.7M
Curative Care Network, Inc.	WI	Rehabilitation Clinic/Center	$0	$12.2M
Children's Specialty Group, Inc.	WI	Pediatrics Physician	$0	$10.4M
Brian Blocher	WI	Oral & Maxillofacial Surgery (D.M.D.)	$0	$5.5M

Option Care Home Care Inc — Billing Profile & Reimbursement Data

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Option Care Home Care Inc — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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