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

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

Abc Pediatric Therapy LLC (NPI 1134152861)

Abc Pediatric Therapy LLC is a physical therapist provider located in West Chester, Ohio. This profile covers 0 Medicare and 26 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	Abc Pediatric Therapy LLC
Address	7591 Tylers Place Blvd
City	West Chester
State	OH
ZIP	45069
Taxonomy	Physical Therapist
NPI Enumerated	July 8, 2006

Payer Source	Total Paid
Medicaid	$30.4M
Medicare	$0

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

26 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	170,700	$70	$11.1M
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…	245,850	$40	$9.6M
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.	76,140	$50	$3.9M
92523	A speech–language pathologist (SLP) evaluates the patient's speech sound production for issues such as incorrect pronunciation and patterns.	27,540	$100	$2.8M
97168	The occupational therapist (OT) performs a re–evaluation focusing on changes in the patient's functional, environment, or medical status that results in a revised plan of care; re–evaluation includes…	23,500	$30	$587.4K
92609	The provider performs therapeutic services to enable the patient to make the best use of his speech generating device and also trains the patient’s caregiver.	14,020	$30	$476.6K
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…	2,720	$170	$456.1K
92526	The provider treats a swallowing disorder through medications, rehabilitation, or a feeding tube, to identify the cause of improper functioning.	12,800	$30	$435K
97164	The provider, typically a physical therapist, conducts a physical therapy re–evaluation that includes history review and standardized tests and measures to assess body structure and function; she…	10,050	$40	$371.9K
97112	Neuromuscular reeducation is a therapeutic treatment (exercise) performed by a physician in an attempt to reduce impairments and restore function through the application of clinical skills and/or…	3,350	$40	$120.5K

Showing 1–10 of 26

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Ohio Distribution

Abc Pediatric Therapy LLC — 10 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Ohio

Full comparison — all codes billed, vs. Ohio median

26 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…	25	40	2,980	$230	$1.7M
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…	21	40	990	$120	$317.5K
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…	1	810	2,560	$50	$274.4K
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…	782	840	1,040	$50	$220.1K
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.	4	1,060	1,850	$30	$126.1K
92526	The provider treats a swallowing disorder through medications, rehabilitation, or a feeding tube, to identify the cause of improper functioning.	1	40	580	$70	$90.2K
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	1	220	410	$40	$82.9K
92609	The provider performs therapeutic services to enable the patient to make the best use of his speech generating device and also trains the patient’s caregiver.	1	20	370	$50	$69.4K
97113	The provider instructs and supervises the patient on aquatic therapeutic exercises for one or more areas of the body for a period of 15 minutes.	55	80	540	$60	$67K
92523	A speech–language pathologist (SLP) evaluates the patient's speech sound production for issues such as incorrect pronunciation and patterns.	1	190	60	$100	$56.2K

Showing 1–10 of 26

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Healthy Living Treatment, LLC	OH	Substance Abuse Rehabilitation Facility	$0	$20.5M
West Chester Hospital LLC	OH	General Acute Care Hospital	$0	$19.5M
Industry Lab Diagnostic Partners LLC	OH	Clinical Medical Laboratory	$912.3K	$15.9M
Byram Healthcare Centers, Inc.	OH	Durable Medical Equipment & Medical Supplies	$0	$11.5M
A Haven For Kids, Inc.	OH	Community/Behavioral Health Agency	$0	$10.4M
Catalyst Counseling LLC	OH	Community/Behavioral Health Agency	$0	$7.3M
West Chester Township Trustee	OH	Ambulance	$390K	$695.3K
Soha Mousa	OH	Rheumatology Physician	$979.7K	$0
West Chester Surgical Suites, LLC	OH	Ambulatory Surgical Clinic/Center	$565.2K	$0
Bradford Curt	OH	Neurological Surgery Physician	$391K	$0

Abc Pediatric Therapy LLC — Billing Profile & Reimbursement Data

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Abc Pediatric Therapy LLC — 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