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

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

Abs Utah, P.C. (NPI 1053821728)

Key Findings

Field	Value
Entity Type	Organization
Organization	Abs Utah, P.C.
Address	240 Morris Ave Ste 100
City	Salt Lake City
State	UT
ZIP	84115
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	October 6, 2017

Payer Source	Total Paid
Medicaid	$197.1M
Medicare	$0

ABS UTAH, P.C. is effectively a Medicaid-focused provider with total Medicaid revenue of $197.1M and no Medicare billing on file, making its payer mix essentially single-payer (Medicaid). The entity’s NPI shows it has been enumerated since 2017-10-06 (~9 years ago), indicating nearly a decade of operational history under its current enrollment.

Revenue is extremely concentrated in a narrow set of ABA-related codes: the top three Medicaid codes (97153, 97155, 97151) together account for 98.1% of this provider’s total Medicaid revenue, with 97153 at $160.4M (81.4%), 97155 at $30M (15.2%), and 97151 at $3M (1.5%). This concentration implies that a small cluster of services drives nearly all billed dollars for the entity.

The code mix identifies ABS UTAH as a large applied behavior analysis (ABA) operator: 97153 (technician-delivered adaptive behavior treatment), 97155 (provider-delivered ABA with protocol modification and technician training), and 97151 (provider-administered assessments and plan development) dominate revenue. These codes together suggest a service model built on high-volume technician encounters with clinician oversight and periodic provider assessments.

Operational scale is evident in claims volume and unit payments: 97153 shows 443.1K claims with an average paid/claim of $362, and 97155 shows 158.6K claims with $189 avg paid/claim. The combination of very high claim counts and moderate unit rates is consistent with a labor-intensive, visit-based behavioral therapy delivery model that relies on many technician-led 15-minute units.

ABS UTAH’s statewide competitive standing is dominant for its core services: it ranks #1 of 29 providers in-state for both 97153 and 97155 (100th percentile) and #1 of 13 providers for 97151 (100th percentile). The provider is described as an “extreme outlier, far above typical state volume” for 97153 and 97155 and “notably above typical state volume” for 97151, indicating market leadership and exceptionally large share for these ABA services in Utah.

Beyond the three revenue-driving codes, the provider bills additional related services at much smaller scale: 97156 ($1.4M, caregiver training), 97152 ($1.2M, technician assessment), 90791 ($326.5K, psychiatric evaluation), and psychological-testing codes such as 96130/96131/96137 (combined hundreds of thousands in revenue). These secondary codes show the organization also offers caregiver-focused sessions, technician assessments, and formal psychological testing, but these lines contribute only a sliver of total Medicaid revenue.

A few billing patterns are unique in the dataset: 97152 is reported as $1.2M and ranks #1 of 1 providers in-state (0th percentile; no state peer volume comparison available), which may reflect either sole reporting in the dataset or a service the provider uniquely records in this taxonomy. Several other diagnostic and testing codes (e.g., 90791, 96130 series) are at typical or unremarkable state volumes, indicating the core business is ABA rather than broader psychiatric outpatient care.

The extreme revenue concentration creates operational and reimbursement risk: since the top three codes drive 98.1% of Medicaid revenue, payer policy or reimbursement changes to 97153/97155/97151 could materially impact cash flow. Coupled with the absence of Medicare revenue, ABS UTAH’s financial exposure is heavily tied to Medicaid policy and contracts for ABA services in Utah, making Medicaid reimbursement trends and state-level utilization controls key strategic variables for the entity.

Medicaid: Complete Services Breakdown

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…	443,100	$360	$160.4M
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…	158,560	$190	$30M
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…	14,430	$210	$3M
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…	21,940	$60	$1.4M
97152	A technician, supervised by a physician or other qualified healthcare professional, provides supporting assessment of a patient’s destructive behavior and behavioral problems by interacting directly…	4,750	$250	$1.2M
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	2,820	$120	$326.5K
96130	The provider, physician or other qualified healthcare professional, administers standardized psychological tests to a patient, interprets the results, establishes a treatment plan, and prepares a…	2,540	$100	$243.7K
96131	The provider, physician or other qualified healthcare professional, administers standardized psychological tests to a patient, interprets the results, establishes a treatment plan, and prepares a…	1,540	$110	$175.2K
96137	Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each additional 30 minutes (List…	1,720	$90	$159.8K
96113	The provider administers various standardized tests to diagnose developmental problems in children. He interprets the results and prepares a report. Report this code for each additional 30 minutes of…	420	$220	$91.2K

Showing 1–10 of 15

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Utah Distribution

Abs Utah, P.C. — 5 of 15 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Utah

Full comparison — all codes billed, vs. Utah 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…	1	30	7,130	$260	$8.7M
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…	1	30	2,270	$140	$1.7M
97152	A technician, supervised by a physician or other qualified healthcare professional, provides supporting assessment of a patient’s destructive behavior and behavioral problems by interacting directly…	1	10	4,750	$250	$1.2M
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	10	340	$210	$437.7K
T1015	Clinic visit/encounter, all-inclusive	50	70	270	$110	$376.1K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	11	140	160	$220	$374.1K
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…	1	10	140	$60	$163.1K
96131	The provider, physician or other qualified healthcare professional, administers standardized psychological tests to a patient, interprets the results, establishes a treatment plan, and prepares a…	2	20	80	$280	$147.8K
96130	The provider, physician or other qualified healthcare professional, administers standardized psychological tests to a patient, interprets the results, establishes a treatment plan, and prepares a…	3	20	80	$140	$142.3K
96137	Psychological or neuropsychological test administration and scoring by physician or other qualified health care professional, two or more tests, any method; each additional 30 minutes (List…	2	20	160	$190	$79.9K

Showing 1–10 of 15

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Acorn Care LLC	UT	In Home Supportive Care Agency	$0	$28.3M
Rathburn Healthcare LLC	UT	Home Health Agency	$0	$19.1M
Granite School District	UT	Local Education Agency (LEA)	$0	$10.7M
Salt Lake Homecare	UT	Home Health Agency	$0	$8.7M
Norco, Inc.	UT	Durable Medical Equipment & Medical Supplies	$0	$8M
City Of South Salt Lake	UT	Land Ambulance	$93.1K	$6.7M
Care Advocates LLC	UT	Case Management Agency	$0	$6.2M
Advocates For Independence LLC	UT	Case Management Agency	$0	$5.9M
Discovery House Utah, Inc.	UT	Methadone Clinic	$132.4K	$4.7M
Duramed LLC	UT	Durable Medical Equipment & Medical Supplies	$0	$4.1M

Abs Utah, P.C. — Billing Profile & Reimbursement Data

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Abs Utah, P.C. — 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