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.

Pathways Human Services Of Pennsylvania, LLC (NPI 1043822208)

Key Findings

Field	Value
Entity Type	Organization
Organization	Pathways Human Services Of Pennsylvania, LLC
Address	4731 Route 30 Ste 302&404
City	Greensburg
State	PA
ZIP	15601
Taxonomy	Public Health or Welfare Agency
NPI Enumerated	August 19, 2020

Payer Source	Total Paid
Medicaid	$48M
Medicare	$0

This entity reports no Medicare billing on file and $48M in lifetime Medicaid revenue, making it effectively a single‑payer (Medicaid‑dominant) outpatient behavioral health/ABA provider in scale. The absence of Medicare billing suggests limited or no revenue exposure to older adult medical services commonly reimbursed by Medicare.

Revenue is highly concentrated: the precomputed top three Medicaid codes account for 66.1% of this provider’s total Medicaid revenue, driven by 90834 ($12.2M, 25.4%), 97153 ($11.2M, 23.4%), and 97155 ($8.3M, 17.3%). Those three codes together represent the majority of the $48M Medicaid footprint, indicating concentrated dependence on a small set of service lines.

The mix of top codes indicates an operation focused on psychotherapy and applied behavior analysis (ABA): high-volume psychotherapy code 90834 (140.3K claims, $87 avg paid/claim) sits alongside large ABA volumes for technician-delivered treatment 97153 (74.8K claims, $150 avg paid/claim) and clinician-directed ABA 97155 (53.8K claims, $154 avg paid/claim). This combination suggests integrated programs that deliver both traditional psychotherapy and structured ABA services, with billable units measured in time-based increments.

Operational implications: extremely large claim counts for 15‑minute ABA codes (e.g., 140.3K claims for 90834, 74.8K for 97153, 53.8K for 97155) imply substantial front-line staffing of technicians and a significant supervisory cadre to support clinician-level 97155 services. The reliance on time-based codes (15‑minute increments) points to business models that scale through high visit frequency and distributed technician delivery rather than low-frequency, high-intensity procedures.

Competitive standing in-state is strong to dominant for the principal codes: 90834 ranks #4 of 692 providers (100th percentile; extreme outlier, far above typical state volume), 97155 ranks #2 of 151 providers (99th percentile; extreme outlier), and 97153 ranks #10 of 145 (94th percentile; notably above typical state volume). These ranks indicate the provider is a major statewide player for both psychotherapy and clinician-supervised ABA services rather than a marginal participant.

The broader Medicaid code mix shows both psychotherapy breadth and ancillary behavioral health services: 90837 ($3.7M, 7.8%), 97151 ($2.2M, 4.5%), and 90832 ($2M, 4.2%) reflect multiple session lengths and assessment/planning activity, while H0034 ($1.1M), H0032 ($902.4K), and H2021 ($752.3K) indicate medication training/support, service plan development, and community wraparound services are also billed. Several of these ancillary codes are in typical volume percentiles (e.g., H0034 at the 91th percentile; typical, unremarkable volume), showing that the provider’s dominance is concentrated on a few high-volume therapeutic and ABA codes.

Tenure and administrative profile: the provider’s NPI was enumerated on 2020-08-19 (~6 years ago), reflecting a moderate recent enrollment window. For payers and competitive analysts, that relatively recent NPI plus a heavy Medicaid concentration suggests monitoring operational scalability and continuity of high-volume ABA/psychotherapy delivery as key due‑diligence items.

Given the $48M Medicaid revenue concentration and no Medicare billing on file, payers should treat this organization as highly Medicaid‑dependent and heavily focused on high-frequency behavioral health and ABA delivery models; contractual, utilization, and workforce reviews should prioritize the top codes 90834, 97153, and 97155 because they drive the bulk of revenue and demonstrate outlier-level statewide activity.

Medicaid: Complete Services Breakdown

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

23 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	140,300	$90	$12.2M
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…	74,830	$150	$11.2M
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…	53,790	$150	$8.3M
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	31,390	$120	$3.7M
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…	18,430	$120	$2.2M
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	42,430	$50	$2M
90792	In this procedure, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis. In addition to the diagnostic evaluation, he also renders some additional medical…	7,920	$160	$1.2M
H0034	Medication training and support, per 15 minutes	10,650	$100	$1.1M
99211	An established patient presents for an office or other outpatient visit that may not require the presence of a physician or other qualified healthcare professional.	9,860	$100	$975.9K
H0032	Mental health service plan development by non-physician	7,780	$120	$902.4K

Showing 1–10 of 23

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

Pathways Human Services Of Pennsylvania, LLC — 9 of 23 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

23 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…	10	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…	19	20	1,780	$210	$2.6M
H2021	Community-based wrap-around services, per 15 minutes	73	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…	2	150	2,770	$200	$1.4M
H0032	Mental health service plan development by non-physician	63	210	3,020	$130	$1.3M
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	4	690	2,240	$80	$1M
H2014	Skills training and development, per 15 minutes	13	20	370	$140	$1M
H0046	Mental health services, not otherwise specified	37	170	1,200	$130	$909.6K
H2019	Therapeutic behavioral services, per 15 minutes	72	180	3,510	$80	$685K
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…	4	120	1,330	$180	$557.5K

Showing 1–10 of 23

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Westmoreland Casemanagement And Supports, Inc	PA	Case Management Agency	$0	$34.4M
Westmoreland Casemanagement And Supports, Inc.	PA	Case Management Agency	$0	$25M
Clear Day Treatment Of Westmoreland, LLC	PA	Substance Abuse Rehabilitation Facility	$0	$17.7M
Mutual Aid Ambulance Service Inc.	PA	Land Ambulance	$1.9M	$8.1M
Community Psychiatric Centers Outpatient Clinic	PA	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$9.3M
Accessabilities, Inc.	PA	Physical Therapist	$0	$8.3M
Medmark Treatment Centers Of Pennsylvania, Inc.	PA	Methadone Clinic	$102.1K	$7.6M
Westmoreland Regional Hospital	PA	General Acute Care Hospital	$0	$6.8M
Pressley Ridge	PA	Community/Behavioral Health Agency	$0	$6.6M
Express Mobile Diagnostic Services, LLC	PA	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	$1.4M	$1.7M

Pathways Human Services Of Pennsylvania, 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