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

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

Progressive Behavior Systems, PA (NPI 1104956390)

Field	Value
Entity Type	Organization
Organization	Progressive Behavior Systems, PA
Address	512 6th St
City	Rupert
State	ID
ZIP	83350
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	March 6, 2007

Payer Source	Total Paid
Medicaid	$85.8M
Medicare	$0

Key Findings

This provider is effectively single‑payer: there is no Medicare billing on file and total Medicaid revenue is $85.8M, indicating near‑exclusive reliance on Medicaid for billed services. Analysts should treat Medicaid reimbursement policy and state program changes as the primary financial drivers for this entity.

Revenue is highly concentrated: the precomputed top 3 Medicaid codes account for 89.2% of the provider’s Medicaid revenue, led by H2016 at $56.1M (65.4%), followed by H2022 at $14M (16.4%) and H0004 at $6.5M (7.5%). This concentration means a small set of service lines (chiefly comprehensive community supports and wrap‑around services plus behavioral counseling) drives the bulk of cash flow.

The code mix aligns with a Developmentally Disabled Services Day Training Agency operational model: large per‑diem billing for H2016 (Comprehensive community support services) and extensive use of H2015/H2016 per‑15‑minute and per‑diem community support codes, plus H2022 (wrap‑around services) and H0004 (behavioral health counseling). Taken together, the filings point to a business focused on long‑duration community supports and time‑based therapy rather than short acute medical procedures.

Competitive standing by code is mixed but strong on several fronts: H2016 generates the largest share of revenue and ranks #2 of 6 in‑state (80th percentile) which is described as typical volume for that code but still the primary revenue driver. H2022 ranks #5 of 14 (69th percentile) and H0004 ranks #21 of 157 (87th percentile), both characterized as typical statewide volumes, indicating the provider is a meaningful, above‑median participant in behavioral and wrap‑around services.

There is a clear statistical outlier in time‑based comprehensive support: H2015 (Comprehensive community support services, per 15 minutes) shows 31.3K claims and $5.7M revenue (6.6%) and ranks #1 of 45 providers in‑state (100th percentile; extreme outlier). This extreme outlier status signals the provider bills this per‑15‑minute code at far higher volume than peers, reflecting either an operational emphasis on highly time‑granular service delivery or concentrated demand for minute‑based support sessions.

Operational intensity is visible in claim counts and unit economics: the dataset shows high claim volumes for time‑based codes (H2015 31.3K claims, H0004 24.2K claims, and 97537 with 74.2K claims) while average paid per claim varies widely (e.g., $21 for 97537 vs $267 for H0004). The combination of very high unit counts with low‑value units (97537) and fewer higher‑paid therapy units suggests a mixed revenue model that depends on scale of delivered minutes as much as on higher‑priced counseling.

From a risk and strategic perspective, the heavy dependence on a small set of Medicaid service codes (top three = 89.2% of Medicaid revenue) and the absence of Medicare revenue create exposure to Medicaid rate adjustments, code redefinitions, or programmatic changes. For payers and network planners, a disruption to rates or eligibility in these specific community‑support and wrap‑around codes could materially affect this provider’s financial position.

The provider has an established tenure in the market, with NPI enumeration dated 2007-03-06 (~19 years ago), and its high rankings on several in‑state code lists—most notably the #1 position on H2015—indicate an entrenched local footprint in Idaho’s developmental disability and community support services market. This longevity plus dominant positions on select codes supports the view of a stable, specialized state‑level operator rather than a new entrant or marginal participant.

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
H2016	Comprehensive community support services, per diem	13,520	$4,150	$56.1M
H2022	Community-based wrap-around services, per diem	6,620	$2,120	$14M
H0004	Behavioral health counseling and therapy, per 15 minutes	24,170	$270	$6.5M
H2015	Comprehensive community support services, per 15 minutes	31,280	$180	$5.7M
97537	In this procedure, the provider works one on one with a patient to provide community work reintegration training. The training helps the injured or ill patient to return to employment and the…	74,160	$20	$1.6M
H2032	Activity therapy, per 15 minutes	19,190	$50	$959.6K
H2019	Therapeutic behavioral services, per 15 minutes	2,880	$180	$511.9K
96152	N/A	1,190	$310	$368.9K
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…	1,700	$60	$102.2K
T1027	Family training and counseling for child development, per 15 minutes	950	$30	$32.2K

Showing 1–10 of 14

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Idaho Distribution

Progressive Behavior Systems, PA — 1 of 14 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Idaho

Full comparison — all codes billed, vs. Idaho median

14 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
H2016	Comprehensive community support services, per diem	2	10	2,910	$1,720	$17.9M
H2022	Community-based wrap-around services, per diem	5	10	6,010	$820	$8.9M
H0004	Behavioral health counseling and therapy, per 15 minutes	21	160	4,020	$140	$1.6M
H2032	Activity therapy, per 15 minutes	21	40	19,190	$50	$1.6M
97537	In this procedure, the provider works one on one with a patient to provide community work reintegration training. The training helps the injured or ill patient to return to employment and the…	6	40	30,150	$20	$1.2M
H2019	Therapeutic behavioral services, per 15 minutes	32	60	2,960	$120	$609.8K
96152	N/A	50	70	2,270	$80	$608.8K
H2015	Comprehensive community support services, per 15 minutes	1	50	2,960	$100	$570.3K
H0005	Alcohol and/or drug services; group counseling by a clinician	66	80	2,240	$50	$257.3K
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…	151	410	740	$60	$174.3K

Showing 1–10 of 14

Nearby Providers

Other providers in the same ZIP code as Progressive Behavior Systems, PA, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Minidoka County School District #331	ID	Local Education Agency (LEA)	$0	$4.6M
Family Health Services Corporation	ID	Federally Qualified Health Center (FQHC)	$0	$4.3M
Minidoka Memorial Hospital	ID	Rural Health Clinic/Center	$0	$2M
Family Vision And Eye Care PA	ID	Optometrist	$0	$481.4K
Minidoka Memorial Hospital	ID	Critical Access Hospital	$0	$361K
Christine Pickup	ID	Audiologist	$4.2K	$0
Jared Keller	ID	Physician Assistant	$1.4K	$0

Progressive Behavior Systems, PA — Billing Profile & Reimbursement Data

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Progressive Behavior Systems, PA — 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