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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Highlights Healthcare, LLC (NPI 1366047474)

Field	Value
Entity Type	Organization
Organization	Highlights Healthcare, LLC
Address	647 Brawley School Rd Ste 104
City	Mooresville
State	NC
ZIP	28117
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	December 4, 2020

Payer Source	Total Paid
Medicaid	$51.1M
Medicare	$0

Key Findings

HIGHLIGHTS HEALTHCARE, LLC is effectively a single-payer Medicaid provider: the profile shows no Medicare billing on file and $51.1M in lifetime Medicaid revenue, indicating the organization’s operations and revenue are concentrated almost entirely in the Medicaid market rather than serving Medicare populations. This payer mix implies the provider’s clinical and commercial efforts are focused on pediatric/developmental services commonly reimbursed by Medicaid.

Medicaid revenue concentration is extremely high: the precomputed top three Medicaid codes account for 97.1% of the provider’s total Medicaid revenue, with 97153 alone representing $38.8M (76.0% of Medicaid revenue). This means the business is heavily dependent on a narrow set of behavioral health services for its financial performance.

Service-line implications from the top codes indicate the organization primarily delivers applied behavior analysis (ABA) services and technician-delivered adaptive behavior treatments. The dominant presence of 97153 (technician-delivered ABA), 97155 (clinician-delivered ABA with protocol modification), and 97152 (technician assessment of destructive behavior) points to an operational model built around high-volume, time-based ABA therapy sessions and supervisory clinical oversight.

Competitive standing in-state is strong for the provider’s core codes: the provider ranks #3 of 88 for 97153 and #3 of 84 for 97155 (both in the 98th percentile), which signals notably above-typical state volume for those services and positions the firm as one of the leading Medicaid ABA providers in North Carolina for those codes. The provider is an extreme outlier for 97152, ranking #1 of 26 (100th percentile), underscoring market leadership specifically for technician assessments of destructive behavior.

Payment mix and unit economics: reported average paid per claim values show material differences across the top codes — $388 avg paid/claim for 97153, $223 for 97155, and $277 for 97152 — indicating that the bulk of revenue derives from high-volume, moderately high-paid technician sessions rather than a large number of high-fee clinician-only procedures. Given 97153 accounts for 76.0% of Medicaid revenue, the provider’s revenue is driven by frequent, time-based technician encounters.

Tenure and market presence: the provider’s NPI was enumerated on 2020-12-04 (~6 years ago), indicating it has established operations for multiple years and achieved rapid scale in Medicaid ABA billing within that timeframe to reach $51.1M in lifetime Medicaid revenue. The combination of recent enumeration and high rank for key codes suggests fast growth in the state ABA market.

Operational risk and business sensitivity: because 97.1% of Medicaid revenue comes from the top three ABA-related codes, the provider’s business is highly sensitive to changes in Medicaid reimbursement policy, prior authorization practices, or utilization management specifically targeting ABA services. Any payer-level policy shifts affecting 97153, 97155, or 97152 could disproportionately affect overall revenue.

Service breadth and clinical mix: beyond the three dominant ABA codes, remaining services collectively represent a very small share of revenue (about 2.9% by precomputed share), with several additional ABA-related codes (97151, 97156, 97154, 97157) appearing at modest volumes. This pattern indicates the provider focuses on direct ABA therapy and assessments with limited diversification into other behavioral health or ancillary services.

Medicaid: Complete Services Breakdown

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

7 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…	100,060	$390	$38.8M
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…	41,140	$220	$9.2M
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…	5,710	$280	$1.6M
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…	4,160	$240	$997.9K
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…	5,300	$60	$318.2K
97154	A technician, supervised by a physician or other qualified healthcare professional, administers adaptive behavior treatments that target conditions such as developmental disabilities associated with…	4,430	$40	$177K
97157	The provider discusses multiple patients’ adaptive behavior treatment face–to–face with a group of guardians or caregivers, without the respective patients being present. Report this code for each 15…	60	$40	$2K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Highlights Healthcare, LLC — 3 of 7 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

7 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…	3	90	5,820	$310	$6.4M
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…	3	80	2,260	$190	$1.4M
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…	6	40	580	$210	$309.6K
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	30	110	$260	$173K
97154	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	10	2,510	$60	$164.1K
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…	7	70	1,020	$70	$152.1K
97157	The provider discusses multiple patients’ adaptive behavior treatment face–to–face with a group of guardians or caregivers, without the respective patients being present. Report this code for each 15…	6	10	170	$80	$24.1K

Nearby Providers

Other providers in the same ZIP code as Highlights Healthcare, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Lolly Therapeutics, LLC	NC	Occupational Therapist	$0	$32.2M
Dudley's Home Health, Inc.	NC	Home Health Agency	$0	$10.7M
Integrative Wellness Solutions, PLLC	NC	Psychologist	$0	$8.5M
Dijana Christianson	NC	Internal Medicine Physician	$1.5M	$0
Sean Fahey	NC	Rheumatology Physician	$1.2M	$0
Craig Dubois	NC	Neurology Physician	$821.1K	$0
Tushar Patel	NC	Specialist	$543.1K	$0
Bishr Al Dabagh	NC	MOHS-Micrographic Surgery Physician	$540.9K	$0
John Konefal	NC	Radiation Oncology Physician	$509.5K	$0
David Konstandt	NC	Urology Physician	$338.5K	$0

Highlights Healthcare, LLC — Billing Profile & Reimbursement Data

Sign up for Highlights Healthcare, LLC — Billing Profile & Reimbursement Data policy alerts

Highlights Healthcare, LLC — Billing Profile & Reimbursement Data

Sign up for Highlights Healthcare, LLC — 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