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NPI 1053341859 · Lancaster, PA · Community/Behavioral Health Agency
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T.w. Ponessa & Associates Counseling Services, Inc. is a community/behavioral health agency provider located in Lancaster, Pennsylvania. This profile covers 0 Medicare and 22 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Organization |
| Organization | T.w. Ponessa & Associates Counseling Services, Inc. |
| Address | 410 N. Prince Street |
| City | Lancaster |
| State | PA |
| ZIP | 17603 |
| Taxonomy | Community/Behavioral Health Agency |
| NPI Enumerated | July 4, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $63.5M |
| Medicare | $0 |
T.W. PONESSA & ASSOCIATES COUNSELING SERVICES, INC. is effectively a Medicaid-focused provider: there is no Medicare billing on file while total Medicaid revenue is $63.5M, indicating a single‑payer concentration of operations and revenue toward state Medicaid programs. This payer mix implies strategic dependence on Medicaid reimbursement and service lines that are primarily covered by Medicaid.
Revenue is highly concentrated in a small set of service lines: the top three Medicaid codes (H2021, H0032, and 90837) together account for 73.9% of the provider’s total Medicaid revenue. Those three codes individually represent $21.3M (H2021), $14.1M (H0032), and $11.5M (90837) of reported Medicaid revenue, underlining that a few high-volume community mental health and psychotherapy services drive most of the business.
The code mix points to an organizational focus on intensive community behavioral health and psychotherapy services. Large volumes in H2021 (Community-based wrap-around services; 177.8K claims) and H0032 (Mental health service plan development; 105.5K claims), combined with high-volume long psychotherapy sessions under 90837 (141.8K claims), suggest the entity operates extensive care‑coordination, wrap‑around, and psychotherapy programs rather than isolated medical visits.
For multiple leading codes the provider is a statewide outlier: H2021 ranks #2 of 218 providers in-state and is described as an "extreme outlier, far above typical state volume for this code," H0032 ranks #2 of 209 and is also an "extreme outlier, far above typical state volume for this code," and 90837 ranks #2 of 555 with the same extreme outlier characterization. These rank and label combinations indicate the provider is a dominant or major player in Pennsylvania for those specific service lines and likely holds significant market share in community wrap-around and intensive psychotherapy services.
Beyond the top three, other codes show elevated but more mixed standing: 90834 (69.5K claims, $4.7M) is 96th percentile and described as "notably above typical state volume for this code," H2019 (29.6K claims, $2.6M) is 94th percentile and also "notably above typical state volume for this code," while 97153 and 97155 (ABA‑related codes) are described as "typical, unremarkable volume for this code." This pattern indicates the organization’s strongest differentiation is in wrap‑around and care‑planning plus long psychotherapy, with some supplemental behavioral/ABA services at more standard volumes.
High claim counts for assessment and brief-screening services are noteworthy: 96127 shows 57K claims with $399.3K revenue and is ranked #1 of 944 providers in-state, labeled an "extreme outlier, far above typical state volume for this code." The combination of very high claim volumes for both comprehensive and brief assessment codes suggests standardized screening and frequent encounter-level documentation are core operational features, supporting throughput for therapy and wrap‑around programs.
Operational scale implications are substantial: hundreds of thousands of claims across several codes (e.g., 177.8K claims for H2021, 141.8K claims for 90837, 105.5K claims for H0032) imply a large multi‑disciplinary workforce and infrastructure to deliver continuous community‑based services and frequent psychotherapy. The provider’s tenure (NPI enumerated 2006-07-04, ~20 years ago) further supports that this scale is sustained over a long period, which may reflect established referral relationships and program capacity within the state Medicaid network.
While the top codes dominate revenue, several lower-revenue codes are present at typical state volumes (for example, 97153 and 97155 labeled as "typical, unremarkable volume for this code"), indicating some service diversification beyond the high‑revenue lines. This mix suggests the provider can offer a range of behavioral health services while relying predominantly on a narrow set of high-volume, Medicaid‑reimbursed community and psychotherapy codes for the bulk of its revenue.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
22 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| H2021 | Community-based wrap-around services, per 15 minutes | 177,820 | $120 | $21.3M |
| H0032 | Mental health service plan development by non-physician | 105,500 | $130 | $14.1M |
| 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… | 141,780 | $80 | $11.5M |
| 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… | 69,490 | $70 | $4.7M |
| 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… | 15,060 | $200 | $3M |
| H2019 | Therapeutic behavioral services, per 15 minutes | 29,570 | $90 | $2.6M |
| 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… | 6,360 | $280 | $1.8M |
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 10,560 | $80 | $823.4K |
| 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… | 3,650 | $180 | $671.8K |
| 90847 | A provider meets with the patient’s family with the patient present to counsel the family on the psychological issues affecting the patient and the family. The provider supplies psychotherapy to the… | 6,370 | $80 | $490.3K |
Showing 1–10 of 22
How this provider's Medicaid billing volume and revenue compare to other Pennsylvania providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Pennsylvania median
22 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… | 44 | 150 | 8,280 | $220 | $4.1M |
| H2021 | Community-based wrap-around services, per 15 minutes | 2 | 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… | 43 | 150 | 2,770 | $200 | $1.4M |
| H0032 | Mental health service plan development by non-physician | 2 | 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… | 31 | 690 | 2,240 | $80 | $1M |
| H2014 | Skills training and development, per 15 minutes | 4 | 20 | 370 | $140 | $1M |
| H0046 | Mental health services, not otherwise specified | 46 | 170 | 1,200 | $130 | $909.6K |
| H0015 | Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including… | 140 | 150 | 2,970 | $100 | $699.4K |
| H2019 | Therapeutic behavioral services, per 15 minutes | 11 | 180 | 3,510 | $80 | $685K |
| 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… | 2 | 560 | 1,400 | $90 | $485.7K |
Showing 1–10 of 22
Other providers in the same ZIP code as T.w. Ponessa & Associates Counseling Services, Inc., ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Union Community Care | PA | Federally Qualified Health Center (FQHC) | $0 | $21.2M |
| The County Of Lancaster | PA | Case Management Agency | $0 | $17M |
| Lancaster Emergency Medical Services Association | PA | Land Ambulance | $2.1M | $10.9M |
| Ars Of Lancaster, LP | PA | Methadone Clinic | $163.8K | $8.3M |
| The County Of Lancaster | PA | Case Manager/Care Coordinator | $0 | $8.2M |
| Childrens Surgery Center, LLC | PA | Ambulatory Surgical Clinic/Center | $0 | $8.1M |
| Glenn Kline | PA | Surgery Physician | $743.4K | $460 |
| Francis Manning | PA | Ophthalmology Physician | $526.4K | $0 |
| Adam Thode | PA | Ophthalmology Physician | $395K | $0 |
| Ryan Yealy | PA | Optometrist | $284.2K | $42.9K |
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