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

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

Beyond Behavior Consulting (NPI 1043637747)

Beyond Behavior Consulting is a behavior analyst provider located in Forty Fort, Pennsylvania. This profile covers 0 Medicare and 15 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	Beyond Behavior Consulting
Address	43 Virginia Ter
City	Forty Fort
State	PA
ZIP	18704
Taxonomy	Behavior Analyst
NPI Enumerated	March 20, 2014

Payer Source	Total Paid
Medicaid	$10.3M
Medicare	$0

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

15 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…	39,940	$190	$7.7M
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…	8,690	$180	$1.6M
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…	1,870	$130	$244.4K
97154	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	740	$240	$180.6K
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.	5,040	$30	$146.1K
H2021	Community-based wrap-around services, per 15 minutes	1,650	$90	$140.2K
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…	1,570	$60	$100.5K
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…	5,410	$20	$97.4K
92526	The provider treats a swallowing disorder through medications, rehabilitation, or a feeding tube, to identify the cause of improper functioning.	2,450	$40	$88.2K
H0046	Mental health services, not otherwise specified	540	$60	$34.4K

Showing 1–10 of 15

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Beyond Behavior Consulting — 0 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

15 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…	14	150	8,280	$220	$4.1M
97154	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	15	20	1,780	$210	$2.6M
H2021	Community-based wrap-around services, per 15 minutes	147	220	3,810	$100	$1.5M
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…	34	150	2,770	$200	$1.4M
H0046	Mental health services, not otherwise specified	113	170	1,200	$130	$909.6K
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…	53	120	1,330	$180	$557.5K
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…	56	410	1,130	$60	$455.4K
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.	67	710	320	$40	$241.4K
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…	26	100	530	$120	$196.1K
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…	1,049	1,280	390	$40	$104.8K

Showing 1–10 of 15

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Keystone Behavior Services, LLC	PA	Community/Behavioral Health Agency	$0	$6.1M
Luzerne Intermediate Unit #18	PA	Community/Behavioral Health Agency	$0	$5.7M
Bruce Saidman	PA	Hematology & Oncology Physician	$3.4M	$1
David Greenwald	PA	Hematology & Oncology Physician	$2.7M	$590
Erik Kruger	PA	Ophthalmology Physician	$2.4M	$11.8K
Surgical Specialty Center Of Northeastern Pennsylvania, LLC	PA	Ambulatory Surgical Clinic/Center	$1.5M	$124.1K
Anthony Andrews	PA	Ophthalmology Physician	$1.3M	$100
Radu Pacurariu	PA	Ophthalmology Physician	$1M	$0
Mark Grohol	PA	Optometrist	$221.5K	$697.4K
Gateway Surgery Center LLC	PA	Ambulatory Surgical Clinic/Center	$756.7K	$11.8K

Beyond Behavior Consulting — Billing Profile & Reimbursement Data

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Beyond Behavior Consulting — 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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References