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

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

Gateway Pediatric Therapy LLC (NPI 1043622780)

Field	Value
Entity Type	Organization
Organization	Gateway Pediatric Therapy LLC
Address	32100 Telegraph Rd
City	Bingham Farms
State	MI
ZIP	48025
Taxonomy	Behavior Analyst
NPI Enumerated	May 29, 2014

Payer Source	Total Paid
Medicaid	$125M
Medicare	$0

Key Findings

This provider is effectively a Medicaid-only operator: there is no Medicare billing on file and all reported program revenue is Medicaid-based, totaling $125M. The absence of Medicare activity combined with a large Medicaid footprint indicates the organization’s commercial strategy and reimbursement exposure are concentrated entirely within state Medicaid programs. The NPI was enumerated on 2014-05-29 (~12 years ago), evidencing an established presence in the market.

Revenue for this provider is extremely concentrated in a narrow set of ABA-related codes: the precomputed top-three codes account for 92.8% of its total Medicaid revenue. Specifically, 97153 generates $80M (64.0% of Medicaid revenue), 97155 generates $26M (20.8%), and 0365T generates $9.9M (7.9%), making these three codes the primary drivers of the practice’s financial performance.

The code mix strongly indicates this is an applied behavior analysis (ABA)-centric operation that relies heavily on technician-delivered, time-based services. High-volume codes such as 97153 (technician-delivered adaptive behavior treatment reported per 15 minutes) and 97155 (provider-delivered behavior treatment per 15 minutes with modification/supervision) reflect a service model built around frequent, short-interval therapy units and supervisory oversight. The presence of behavior-treatment add-on codes (0365T) further supports a workflow of standardized ABA sessions with supplementary billed components.

Claim-volume metrics reinforce the scale of the ABA operation: 97153 has 430.3K claims, 97155 has 150.5K claims, and 0365T has 55.9K claims, indicating very large service volumes rather than a boutique or low-utilization practice. These volumes, paired with the dollar revenues for each code, imply substantial staffing of technicians and supervisors to deliver continuous, short-unit ABA services.

Competitive standing within the state is dominant for core ABA codes: the provider ranks #2 statewide for 97153 (99th percentile; labeled an extreme outlier), #2 for 97155 (99th percentile; extreme outlier), and #2 for 0365T (99th percentile; notably above typical state volume). That consistently high ranking across multiple high-revenue codes positions the entity as one of the largest in-state providers of Medicaid-funded ABA services and a likely market leader in pediatric behavior-therapy capacity.

While the core ABA portfolio is outsized, the provider also bills higher-level assessment and caregiver-training codes, showing clinical breadth beyond technician time. For example, 97151 accounts for $2.1M (1.7% of Medicaid revenue) and ranks #3 in-state (97th percentile; notably above typical), 97156 generates $1.3M (1.0%) and ranks #5 (96th percentile), and 0359T appears at $305.3K (0.2%) and ranks #2 (95th percentile). These codes indicate the organization performs formal assessments, care-plan development, and caregiver-facing training in addition to hands-on therapy.

The provider’s extreme dependence on a few high-volume ABA codes creates sensitivity to any payer policy, coverage, or rate changes that affect those specific codes. Because 92.8% of Medicaid revenue flows from the top three codes, modifications in reimbursement policy, prior-authorization requirements, or audit focus on technician-delivered ABA services could materially impact overall revenue and operations.

Activity outside the primary ABA suite is mixed and often unremarkable by state standards, suggesting limited diversification of service lines. Examples include H0031 ($243.3K, 0.2% of revenue) which ranks #107 of 183 providers in-state (42nd percentile; typical, unremarkable volume) and T2025 ($126.5K, 0.1%) which ranks #19 of 34 (45th percentile; typical, unremarkable volume). These placements imply the provider’s strength and competitive differentiation are concentrated in ABA treatment codes rather than ancillary mental-health or waiver categories.

Medicaid: Complete Services Breakdown

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

14 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
97153	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	430,300	$190	$80M
97155	The provider, a physician or other qualified healthcare professional, administers adaptive behavior treatment face–to–face with one patient and makes modifications in the protocol targets and…	150,470	$170	$26M
0365T	Adaptive behavior tx addl	55,910	$180	$9.9M
0369T	Duodenal mucosal resurfacing, endoscopic	12,140	$210	$2.6M
97151	The provider, a physician or other qualified healthcare professional, identifies the adaptive or maladaptive behavior of the patient by administering several different types of tests in person; he…	6,360	$330	$2.1M
0364T	Behavior treatment	50,980	$30	$1.4M
97156	The provider discusses a patient’s adaptive behavior treatment face–to–face with the guardian(s) or caregiver(s), with or without the patient present. Report this code for each 15 minutes that the…	22,720	$60	$1.3M
0368T	Behavior treatment modified additional	12,200	$60	$719.7K
0359T	Behavior identification assessment, by the physician or other qualified health care professional, face-to-face with patient and/or guardian(s)/caregiver(s), includes administration of standardized…	650	$470	$305.3K
H0031	Mental health assessment, by non-physician	720	$340	$243.3K

Showing 1–10 of 14

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Michigan Distribution

Gateway Pediatric Therapy LLC — 9 of 14 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Michigan

Full comparison — all codes billed, vs. Michigan median

14 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97153	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	2	130	11,590	$190	$7.6M
T2025	Waiver services; not otherwise specified (nos)	19	30	2,980	$100	$2.3M
97155	The provider, a physician or other qualified healthcare professional, administers adaptive behavior treatment face–to–face with one patient and makes modifications in the protocol targets and…	2	130	3,170	$180	$2.2M
0365T	Adaptive behavior tx addl	2	70	3,180	$170	$1.5M
H0031	Mental health assessment, by non-physician	107	180	1,290	$250	$1.1M
97151	The provider, a physician or other qualified healthcare professional, identifies the adaptive or maladaptive behavior of the patient by administering several different types of tests in person; he…	3	60	200	$380	$398.1K
0369T	Duodenal mucosal resurfacing, endoscopic	2	70	740	$160	$299.1K
97156	The provider discusses a patient’s adaptive behavior treatment face–to–face with the guardian(s) or caregiver(s), with or without the patient present. Report this code for each 15 minutes that the…	5	100	910	$90	$283.6K
0364T	Behavior treatment	2	70	2,990	$30	$231.4K
0368T	Behavior treatment modified additional	2	70	900	$60	$131K

Showing 1–10 of 14

Nearby Providers

Other providers in the same ZIP code as Gateway Pediatric Therapy LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Heritage Labs, Inc.	MI	Clinical Medical Laboratory	$12M	$2.3M
Byram Healthcare Centers, Inc.	MI	Durable Medical Equipment & Medical Supplies	$0	$5.3M
Catalyst Diagnostic LLC	MI	Clinical Medical Laboratory	$400.9K	$1.7M
Anu Patel	MI	Ophthalmology Physician	$1M	$0
Michigan Community Wellness Vna, LLC	MI	Nursing Care Agency	$161.6K	$582.7K
Direct Path Services, P.C.	MI	Clinical Medical Laboratory	$444.8K	$122.4K
Justin Trivax	MI	Cardiovascular Disease Physician	$534.2K	$0
Mark Karadsheh	MI	Orthopaedic Surgery Physician	$383.3K	$0
Steven Korotkin	MI	Cardiovascular Disease Physician	$375.4K	$0
Karl Kado	MI	Diagnostic Radiology Physician	$356.4K	$0

Gateway Pediatric Therapy LLC — Billing Profile & Reimbursement Data

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Gateway Pediatric Therapy 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