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

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

Autism Behavioral Institute, LLC (NPI 1396393930)

Field	Value
Entity Type	Organization
Organization	Autism Behavioral Institute, LLC
Address	100 Bull St Ste 200
City	Savannah
State	GA
ZIP	31401
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	August 27, 2019

Payer Source	Total Paid
Medicaid	$15.2M
Medicare	$0

Key Findings

NPI and organizational profile: AUTISM BEHAVIORAL INSTITUTE, LLC is registered as a Community/Behavioral Health Agency and was enumerated on 2019-08-27 (~7 years ago), indicating several years of active Medicaid participation in Georgia since initial enrollment. This tenure supports the development of sustained operational capacity in pediatric developmental/behavioral services.

Payer mix and scale: This provider has no Medicare billing on file and is effectively a single-payer Medicaid operation, with total Medicaid revenue of $15.2M reported. The absence of Medicare activity means analyses of scale and risk should focus on Medicaid policy and managed-care contracts rather than Medicare trends.

Concentration of Medicaid revenue: Revenue is highly concentrated in three codes, with the top 3 Medicaid codes by revenue accounting for 95.6% of the provider's total Medicaid revenue. The three drivers are 97153 ($10.9M, 72.2% of Medicaid revenue), 97155 ($2.8M, 18.2%), and 97151 ($780.7K, 5.2%), making these line items the primary determinants of overall financial performance.

Service-line interpretation: The dominant codes—97153 and 97155—correspond to technician-delivered and provider-delivered adaptive behavior treatments (ABA), and 97151 corresponds to initial assessment/plan-of-care time, indicating the organization operates as a high-volume ABA provider that pairs large volumes of supervised technician sessions with clinician oversight and assessment. High claim counts (e.g., 49.5K claims for 97153 and 15.8K claims for 97155) corroborate a volume-driven, session-based service model.

Competitive standing in-state: For the major codes the provider ranks at the top of its in-state peer sets—97153 ranks #1 of 9 providers (100th percentile), 97155 ranks #1 of 8 providers (100th percentile), and 97151 ranks #1 of 3 providers (100th percentile)—signaling a dominant statewide position in delivering these ABA services. These rank/percentile metrics indicate the provider is a major player in Georgia for the codes that drive its revenue.

Statistical outliers and peer comparisons: Several high-volume codes are labeled "notably above typical state volume" (97153, 97155, 96112), signaling materially higher utilization than typical in-state peers; by contrast, 97151 and 97156 are described as "typical, unremarkable volume" within their peer groups. A few codes (96113 and 97154) report a 0th percentile or no state peer volume comparison available, which limits peer-based interpretation for those specific line items.

Operational implications from unit economics: The average paid per claim and claim counts suggest a standardized, frequent-session delivery model—97153 shows $221 avg paid/claim across 49.5K claims and 97155 shows $175 avg paid/claim across 15.8K claims—pointing to reliance on many short, billable units (15-minute increments) delivered predominantly by technicians under supervision. This pattern implies operational emphasis on clinician supervision infrastructure and scalable technician staffing.

Revenue concentration risk and commercial considerations: Given that the top 3 codes produce 95.6% of Medicaid revenue, policy changes, rate adjustments, or utilization management focused on ABA codes—especially 97153 and 97155—would have a disproportionate financial impact. Analysts and payers should prioritize contract terms, utilization trends, and medical-necessity controls for these specific codes when assessing financial and operational risk.

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…	49,480	$220	$10.9M
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…	15,800	$180	$2.8M
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…	4,820	$160	$780.7K
96112	The provider administers various standardized tests to diagnose developmental problems in children. He interprets the results and prepares a report. Report this code for the first hour of test…	3,260	$90	$286.7K
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…	3,160	$70	$214.9K
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…	2,140	$70	$143.2K
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…	270	$110	$29.1K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Georgia Distribution

Autism Behavioral Institute, LLC — 5 of 7 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Georgia

Full comparison — all codes billed, vs. Georgia 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…	1	10	1,350	$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…	1	10	210	$190	$443.4K
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	210	$160	$272.4K
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…	1	10	3,160	$70	$216K
96112	The provider administers various standardized tests to diagnose developmental problems in children. He interprets the results and prepares a report. Report this code for the first hour of test…	1	10	120	$90	$59.7K
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	80	$70	$50.5K
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…	1	10	270	$110	$29.1K

Nearby Providers

Other providers in the same ZIP code as Autism Behavioral Institute, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Coriander Williams	GA	Mental Health Counselor	$0	$420.7K
Georgia Infirmary, Inc.	GA	Case Manager/Care Coordinator	$0	$294.6K
John Murrell	GA	Podiatrist	$148.6K	$0
Teresa Ashman	GA	Psychologist	$100.1K	$0
Nicholas Holley	GA	Physical Therapist	$93.8K	$0
Alyson Bonner	GA	Occupational Therapist	$80.9K	$0
Andrea Tanner	GA	Family Nurse Practitioner	$14.9K	$0

Autism Behavioral Institute, LLC — Billing Profile & Reimbursement Data

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Autism Behavioral Institute, LLC — 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