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

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

Piece By Piece Autism Center (NPI 1275032096)

Field	Value
Entity Type	Organization
Organization	Piece By Piece Autism Center
Address	602 Ransdell Rd
City	Lebanon
State	IN
ZIP	46052
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	February 7, 2018

Payer Source	Total Paid
Medicaid	$47.8M
Medicare	$0

Key Findings

PIECE BY PIECE AUTISM CENTER appears to operate effectively as a single-payer Medicaid provider: Total Medicare revenue is none (no Medicare billing on file) while Total Medicaid revenue is $47.8M. The entity’s NPI was enumerated 2018-02-07 (~8 years ago), indicating several years of active Medicaid billing during that tenure.

Revenue is highly concentrated in a very small set of service codes: the precomputed top-3 Medicaid codes account for 99.8% of the provider’s Medicaid revenue. In particular, 97153 alone accounts for $41.8M (87.6% of Medicaid revenue) and 97155 contributes $5.6M (11.6%), with the third top code 97151 at $262.1K (0.5%).

The code mix and descriptions indicate this is an applied behavior analysis (ABA)-centric operation that relies heavily on technician-delivered services (97153) with supervisory or clinician-level modifications (97155) and relatively fewer formal assessments (97151). High volume in 97153 (31.9K claims) versus much lower assessment counts (253 claims for 97151) suggests a business model focused on ongoing treatment sessions delivered by technicians rather than frequent full-length assessment encounters.

Payment and utilization dynamics show a large gap in average paid/claim across top services: 97153 averaged $1311 paid/claim across 31.9K claims, while 97155 averaged $542 paid/claim across 10.3K claims, and 97151 averaged $1036 paid/claim across 253 claims. These figures imply that technician sessions (97153) drive both the lion’s share of revenue and the majority of encounter volume, whereas assessment encounters are higher-paid but much less frequent.

Competitive standing in-state is meaningful but not dominant: 97153 ranks #13 of 96 providers in-state (87th percentile; described as typical, unremarkable volume), and 97155 ranks #14 of 84 providers (84th percentile; typical, unremarkable volume). By contrast, 97151 ranks #19 of 30 (38th percentile), indicating relatively modest presence for assessment services compared with peers — overall this suggests a substantial regional participant for core therapy delivery but not a statewide market leader across all service types.

Operational implications include a heavy dependence on technician staffing and supervisory capacity given the 31.9K claims for 97153 and the supervisory/clinical role implied by 97155 volumes (10.3K claims). The imbalance between high-volume treatment encounters and low assessment counts points to workflows optimized for long-term treatment delivery rather than episodic diagnostic evaluation.

Financial and payer risk is concentrated: with 97153 at 87.6% and 97155 at 11.6% of Medicaid revenue, the provider’s financial performance is highly sensitive to utilization and reimbursement changes for these ABA-related codes. Because Medicare contributes none of the reported revenue, any changes in state Medicaid policy, rates, or utilization management for these codes would materially affect this provider’s revenue base.

Although 97151 carries a higher average paid/claim ($1036) than 97155 ($542), its small volume (253 claims) limits its contribution to revenue and suggests that growth in assessment services could be a pathway to diversify revenue per encounter if capacity exists to increase those evaluations. This distribution implies strategic levers around assessment throughput and clinician-delivered services if the provider seeks to broaden its revenue mix.

Medicaid: Complete Services Breakdown

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

4 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…	31,920	$1,310	$41.8M
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…	10,250	$540	$5.6M
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…	250	$1,040	$262.1K
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…	300	$300	$90.3K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Indiana Distribution

Piece By Piece Autism Center — 0 of 4 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Indiana

Full comparison — all codes billed, vs. Indiana median

4 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…	13	100	3,740	$430	$7.7M
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…	14	80	1,360	$150	$1M
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…	19	30	520	$140	$135.1K
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…	18	40	210	$70	$57.8K

Nearby Providers

Other providers in the same ZIP code as Piece By Piece Autism Center, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Witham Memorial Hospital	IN	Family Medicine Physician	$0	$11M
Lafayette Emergency Physicians, Inc	IN	Emergency Medicine Physician	$0	$9M
Witham Memorial Hospital	IN	General Acute Care Hospital	$0	$5.6M
Integrative Wellness, LLC	IN	Psychiatry Physician	$0	$5.4M
Arc Rehab Services, Inc.	IN	Developmentally Disabled Services Day Training Agency	$0	$2.6M
Zulfiqar Mirza	IN	Cardiovascular Disease Physician	$392.2K	$0
Michael Hornbecker	IN	Internal Medicine Physician	$260.8K	$0
Mehul Patel	IN	Gastroenterology Physician	$56.3K	$0
Christopher Huffer	IN	Pulmonary Disease Physician	$53.4K	$0
Brandon Horn	IN	Orthopaedic Surgery Physician	$52.1K	$0

Piece By Piece Autism Center — Billing Profile & Reimbursement Data

Sign up for Piece By Piece Autism Center — Billing Profile & Reimbursement Data policy alerts

Piece By Piece Autism Center — Billing Profile & Reimbursement Data

Sign up for Piece By Piece Autism Center — Billing Profile & Reimbursement Data policy alerts

Key Findings

Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References