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

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

Access Rehab Centers, LLC (NPI 1033293691)

Key Findings

Field	Value
Entity Type	Organization
Organization	Access Rehab Centers, LLC
Address	22 Tompkins Street
City	Waterbury
State	CT
ZIP	06708
Taxonomy	Rehabilitation Clinic/Center
NPI Enumerated	October 24, 2006

Payer Source	Total Paid
Medicaid	$36.9M
Medicare	$0

ACCESS REHAB CENTERS, LLC is effectively a single‑payer Medicaid provider: it reports $36.9M in lifetime Medicaid revenue and has no Medicare billing on file. Its NPI was enumerated on 2006-10-24 (~20 years ago), indicating long tenure in the market and sustained Medicaid activity over many years.

Revenue is highly concentrated in a small set of therapy codes: the precomputed top three Medicaid codes account for 70.9% of the provider's total Medicaid revenue. Those top codes are 97110 ($14.4M, 38.9%), 97112 ($5.9M, 16.1%), and 97140 ($5.9M, 16.0%), showing that a large share of dollars flows through a narrow set of physical‑therapy procedures.

The code mix and descriptions point to an outpatient, high‑throughput physical therapy operation: 97110 (therapeutic exercise), 97112 (neuromuscular reeducation), and 97140 (manual therapy) are the dominant services by revenue. High claim counts for these codes — 97110 at 422.2K claims, 97112 at 227.8K claims, and 97140 at 255.8K claims — suggest session‑based delivery with heavy visit volume rather than episodic or high‑cost procedures.

Competitive standing within Connecticut is dominant for core PT services: the provider ranks #1 in‑state for 97110 (rank #1 of 348), 97112 (rank #1 of 164), and 97140 (rank #1 of 120), and each of those is described as an "extreme outlier" and in the 100th percentile. Across multiple other codes the provider also sits in very high percentiles (for example, 97530 at the 99th percentile and 97010 at the 100th percentile), which collectively mark it as a major in‑state player in Medicaid rehabilitation.

Beyond the top three, the provider bills a broad set of therapy and related modality codes that extend revenue beyond exercise and manual techniques: 97530 ($2M, 5.3%), 97014 ($1.9M, 5.1%), 97535 ($1.7M, 4.6%), and 92507 ($1.4M, 3.8%) indicate activity in functional therapeutic activities, electrical stimulation, therapeutic instruction, and speech‑language services. The presence of occupational‑therapy and evaluation codes (97161, 97162, 97165) shows multidisciplinary services rather than a single‑technique shop.

Utilization patterns indicate a high‑volume, low‑unit‑price model: many codes have very large claim counts paired with modest average payments per claim — e.g., 97110 at 422.2K claims with $34 avg paid/claim and 97010 at 272.4K claims with $5 avg paid/claim. This profile is consistent with frequent, short duration therapy visits and substantial throughput of Medicaid beneficiaries rather than infrequent, high‑priced interventions.

Multiple individual codes are explicitly flagged as statistical outliers in the dataset (several described as "extreme outlier" and others as "notably above typical state volume"). Those neutral, data‑driven labels (applied to codes such as 97110, 97112, 97140, 97010, 97035, and G0283) indicate utilization that is far above typical in‑state peers and may warrant comparative monitoring or deeper clinical/utilization review by payers focused on program integrity and payment appropriateness.

From a payer contracting and network perspective, the combination of long tenure (NPI 2006-10-24 (~20 years ago)), concentrated Medicaid revenue ($36.9M) and dominant in‑state rankings across core PT codes suggests ACCESS REHAB is a significant provider of outpatient rehabilitation services to Connecticut Medicaid members. Payers evaluating capacity, referral patterns, or reimbursement arrangements should consider this provider's outsized share of Medicaid PT volume and the operational implications of a visit‑based, high‑throughput model.

Medicaid: Complete Services Breakdown

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

31 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	422,230	$30	$14.4M
97112	Neuromuscular reeducation is a therapeutic treatment (exercise) performed by a physician in an attempt to reduce impairments and restore function through the application of clinical skills and/or…	227,800	$30	$5.9M
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	255,820	$20	$5.9M
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	72,740	$30	$2M
97014	The provider, who is typically a physical therapist, applies an electrical current to nerves or to a muscle or group of muscles, causing them to contract. It is used to restore function to a body…	104,070	$20	$1.9M
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	63,500	$30	$1.7M
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	25,230	$60	$1.4M
97010	The provider, such as physical therapist, applies a hot or cold pack to a specific body site to treat an injury or disease.	272,380	$10	$1.4M
97113	The provider instructs and supervises the patient on aquatic therapeutic exercises for one or more areas of the body for a period of 15 minutes.	8,980	$70	$610.8K
97161	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history to rule out any adverse factors that will affect care; observes whether the patient's…	9,950	$60	$566.9K

Showing 1–10 of 31

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Connecticut Distribution

Access Rehab Centers, LLC — 11 of 22 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Connecticut

Full comparison — all codes billed, vs. Connecticut median

31 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	1	350	1,820	$40	$537.3K
92507	The provider treats a patient with communication and hearing difficulties by directly interacting with the patient. He assesses the patient with impairment in his ability to make sounds, along with…	13	150	3,670	$60	$470.9K
97010	The provider, such as physical therapist, applies a hot or cold pack to a specific body site to treat an injury or disease.	1	50	1,420	$20	$338.6K
97161	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history to rule out any adverse factors that will affect care; observes whether the patient's…	10	50	2,660	$50	$256.2K
97113	The provider instructs and supervises the patient on aquatic therapeutic exercises for one or more areas of the body for a period of 15 minutes.	3	20	1,770	$50	$189.5K
97140	Manual therapy is a form of physical therapy which uses the controlled movement and pressure of hands to treat various disorders of soft tissues and joints, eg, chronic back pain. Manual therapy…	1	120	1,140	$10	$178.2K
97035	Physical therapists use different treatment modalities that can help strengthen, relax, and heal muscles from their strained conditions.	1	40	2,930	$40	$157.7K
97530	The provider uses various activities during direct contact with the patient to improve the patient’s functional performance. Use this code for each 15 minutes of activity.	3	230	1,490	$30	$137.2K
97014	The provider, who is typically a physical therapist, applies an electrical current to nerves or to a muscle or group of muscles, causing them to contract. It is used to restore function to a body…	1	30	880	$20	$133.8K
97162	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history to rule out any adverse factors that will affect care; observes whether the patient's…	7	60	490	$50	$131K

Showing 1–10 of 31

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Prospect Waterbury, Inc.	CT	General Acute Care Hospital	$0	$84.6M
Emergency Physicians Of Connecticut PC	CT	Emergency Medicine Physician	$0	$10.8M
Connecticut Counseling Centers Inc	CT	Methadone Clinic	$196.2K	$9.9M
Pediatric Assoc Of Conn PC	CT	Pediatrics Physician	$0	$8.5M
Refocus Eye Health Of Central Connecticut, P.C.	CT	Ophthalmology Physician	$0	$8.2M
Myeyedr Optometry Of Connecticut, LLC	CT	Optometrist	$0	$4.7M
General Hearing	CT	Hearing Instrument Specialist	$0	$4.3M
Connecticut Neurodevelopmental Services	CT	Neurology with Special Qualifications in Child Neurology Physician	$0	$4M
Easter Seal Rehabilitation Center	CT	Rehabilitation Clinic/Center	$0	$3.9M
Bidarkote Somanath	CT	Pediatrics Physician	$0	$3.6M

Access Rehab Centers, LLC — 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