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

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

Tenderheart Health Outcomes, Inc. (NPI 1972583078)

Field	Value
Entity Type	Organization
Organization	Tenderheart Health Outcomes, Inc.
Address	1701 Directors Blvd Ste 520
City	Austin
State	TX
ZIP	78744
Taxonomy	Durable Medical Equipment & Medical Supplies
NPI Enumerated	January 17, 2006

Payer Source	Total Paid
Medicaid	$145.4M
Medicare	$0

Key Findings

TENDERHEART HEALTH OUTCOMES, INC. is effectively a Medicaid-focused DME/supplies provider with $145.4M in reported Medicaid revenue and no Medicare billing on file; its NPI was enumerated 2006-01-17 (~20 years ago), indicating an established operating history but a payer footprint concentrated almost entirely in Medicaid. This single-payer profile means analyses should treat Medicaid policy, rate changes, and state contract dynamics as the primary commercial risks and levers for this entity.

Revenue concentration is high: the precomputed top 3 Medicaid codes by revenue account for 44.3% of the provider’s total Medicaid revenue. Those top three codes include T4527 ($24.1M), A4554 ($19.2M), and T4526 ($18.1M), signaling that a small set of product lines drives nearly half of all reported Medicaid receipts.

The code mix shows a clear operational focus on adult disposable incontinence products and related supplies. High-volume inflows such as T4527 (408.5K claims, $24.1M), T4526 (370.2K claims, $18.1M), T4528 (248.9K claims, $17.4M), and T4535 (569.1K claims, $10.2M) point to large-scale fulfillment and distribution of pull-on underwear, briefs, liners, and underpads rather than episodic durable-equipment rentals.

State-level competitive standing for incontinence and related supply codes is dominant: this provider ranks #1 of many in-state lists (100th percentile) and is repeatedly labeled an "extreme outlier" for volume on codes such as T4527, A4554, T4526, T4528, T4535, and A4335, indicating it operates far above the typical state provider for these items. That pattern establishes it as a major statewide supplier for these product lines and a likely counterparty of interest for managed-Medicaid contracts.

The provider’s services extend beyond incontinence supplies into enteral nutrition, intermittent catheters, and mobility aids, showing product breadth within DME. Examples include B4150 (14.4K claims, $1.9M; ranks #2 of 64, 98th percentile), A4351 (9.7K claims, $1.4M; ranks #5 of 38, 89th percentile), B4160 (6.1K claims, $1.3M), and E0240 (11.2K claims, $965.6K; ranks #1 of 35), which suggests TENDERHEART supports both nutritional and ADL-related needs in addition to continence care.

Observed average paid/claim differences across sizes and product types imply a varied product mix with higher unit payments for larger or specialty items. Examples include T4527 at $59 avg paid/claim, T4528 at $70, and T4544 at $84, while high-claim, low-unit items such as A4335 show $4 avg paid/claim across 1.9M claims; this combination points to a distribution model with very high unit volumes for low-dollar items plus meaningful revenue from higher-priced units.

From a payer or competitor analysis perspective, the combination of concentrated revenue (44.3% in top three codes), extreme statewide volume outlier status on many codes, and a Medicaid-only billing footprint highlights both negotiating leverage and sensitivity to state Medicaid changes. Any shifts in coverage policy, prior authorization, or reimbursement rates for incontinence supplies or enteral formulas could materially affect this provider’s revenue given the concentration and scale of claims.

Operationally, the claim volumes indicate a logistics-heavy business: multiple codes report hundreds of thousands to over a million claims (e.g., A4554 1.3M claims, A4335 1.9M claims, T4527 408.5K claims), requiring significant inventory, distribution, and claims-processing capacity. Analysts should treat service continuity, fulfillment capacity, and state contract terms as key factors when benchmarking this provider against other Medicaid DME suppliers.

Medicaid: Complete Services Breakdown

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

138 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T4527	Adult sized disposable incontinence product, protective underwear/pull-on, large size, each	408,520	$60	$24.1M
A4554	Disposable underpads, all sizes	1,277,480	$20	$19.2M
T4526	Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each	370,200	$50	$18.1M
T4528	Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each	248,910	$70	$17.4M
T4535	Disposable liner/shield/guard/pad/undergarment, for incontinence, each	569,080	$20	$10.2M
T4544	Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each	100,540	$80	$8.4M
A4335	Incontinence supply; miscellaneous	1,907,680	$1	$7.6M
T4523	Adult sized disposable incontinence product, brief/diaper, large, each	96,390	$40	$3.9M
T4534	Youth sized disposable incontinence product, protective underwear/pull-on, each	115,840	$30	$3.8M
T4522	Adult sized disposable incontinence product, brief/diaper, medium, each	92,230	$40	$3.3M

Showing 1–10 of 138

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Texas Distribution

Tenderheart Health Outcomes, Inc. — 21 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Texas

Full comparison — all codes billed, vs. Texas median

138 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
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…	32	40	2,180	$270	$7.2M
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,…	17	50	2,810	$150	$3.2M
B4035	Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	30	60	2,520	$210	$1.8M
T2029	Specialized medical equipment, not otherwise specified, waiver	2	10	470	$330	$1.7M
A4353	Intermittent urinary catheter, with insertion supplies	7	40	1,010	$540	$1.3M
A4239	Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service	26	30	3,080	$150	$1.3M
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…	22	20	630	$1,010	$1.2M
E0603	Breast pump, electric (ac and/or dc), any type	16	20	1,510	$140	$1.1M
B9998	Noc for enteral supplies	28	60	4,690	$90	$1.1M
E1399	Durable medical equipment, miscellaneous	2	60	540	$430	$786.2K

Showing 1–10 of 138

Nearby Providers

Other providers in the same ZIP code as Tenderheart Health Outcomes, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Genotox Laboratories Ltd	TX	Clinical Medical Laboratory	$1.2M	$29M
Central Texas Community Health Centers	TX	Federally Qualified Health Center (FQHC)	$0	$17.3M
Pavan Ganapathiraju	TX	Pulmonary Disease Physician	$15.2K	$0

Tenderheart Health Outcomes, Inc. — Billing Profile & Reimbursement Data

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Tenderheart Health Outcomes, 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