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.

Idaho Falls School District 91 (NPI 1427194521)

Field	Value
Entity Type	Organization
Organization	Idaho Falls School District 91
Address	690 John Adams Pkwy
City	Idaho Falls
State	ID
ZIP	83401
Taxonomy	Local Education Agency (LEA)
NPI Enumerated	January 29, 2007

Payer Source	Total Paid
Medicaid	$11.2M
Medicare	$0

Key Findings

This entity has no Medicare billing on file and is effectively a single-payer Medicaid provider, reporting Total Medicaid revenue of $11.2M. The absence of Medicare activity makes Medicaid the sole material revenue stream to evaluate and positions the organization as dependent on state program volumes and rates rather than a mixed payer book of business.

Revenue is highly concentrated in a small set of service lines: the precomputed top three Medicaid codes account for 67.4% of the provider’s Medicaid revenue. The top individual line, H0004, represents $3.4M (29.9% of total Medicaid revenue), signaling that behavioral health counseling billed in 15-minute units is the single largest revenue driver.

The code mix and descriptions point to a school-based behavioral health and allied-therapy operation consistent with the provider’s taxonomy as a Local Education Agency (LEA). High volumes in H0004 (behavioral health counseling), H2014 (skills training and development), and frequent use of therapy codes such as 97530 and 97110 suggest staffing and operational investment in clinicians who deliver short, frequent, billable sessions (15-minute unit structure) within an educational setting.

H2014 is a standout in the competitive landscape: this provider reports $2.8M from H2014 (24.9% of Medicaid revenue) and ranks #2 of 56 providers in-state (98th percentile; extreme outlier), indicating a dominant statewide position in skills training and development relative to peers. That concentration makes the provider a leading in-state resource for that specific service and suggests enrollment or program scale far above typical state volume.

Other high-volume codes show strong but less singular dominance: H0004 ($3.4M, 29.9%) ranks #18 of 157 providers in-state (89th percentile) and 96152 ($1.4M, 12.7%) ranks #3 of 73 providers in-state (97th percentile), both described as having typical, unremarkable volume despite high percentiles. These entries indicate consistently heavy utilization of behavioral health counseling and test-adjacent services, but not uniformly unique market control across every top code.

Beyond the top three, the provider bills meaningfully for related therapy and support services that align with school-based care delivery: 97530 ($1.1M, 9.6%), H2017 ($764K, 6.8%), and speech/language codes 92507 and 92508 together account for substantial claim counts and revenue. The presence of group education code 99412 ($251.2K) and personal care T1019 ($202.4K) further supports a mixed program of individual therapy, group instruction, and personal care supports typically coordinated by an LEA.

The billing pattern — many high-frequency, low-unit-value claims (numerous 15-minute unit codes, e.g., H0004, H2014, H2017) — implies operational priorities around scheduling, documentation, and clinician time allocation to capture short-duration services. For payers and contracting teams, these characteristics suggest that cost and utilization management efforts should focus on unit-based authorization controls, program eligibility, and service mix rather than episodic or procedure-based interventions.

The provider’s NPI tenure (enumerated 2007-01-29, ~19 years ago) indicates long-standing participation in Medicaid programs; combined with the concentrated revenue mix and the extreme outlier status on H2014, this tenure supports a profile of an established LEA that has scaled specific Medicaid-billable behavioral services over many years. Analysts should view the provider as an entrenched Medicaid service provider whose financial performance is tightly coupled to continued Medicaid coverage of frequent, short-duration behavioral and therapy services.

Medicaid: Complete Services Breakdown

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

22 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H0004	Behavioral health counseling and therapy, per 15 minutes	30,490	$110	$3.4M
H2014	Skills training and development, per 15 minutes	75,380	$40	$2.8M
96152	N/A	31,560	$50	$1.4M
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.	18,570	$60	$1.1M
H2017	Psychosocial rehabilitation services, per 15 minutes	6,370	$120	$764K
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…	13,600	$30	$367.1K
99412	The provider offers advice on maintaining and improving health to a group of patients for roughly an hour.	11,960	$20	$251.2K
H0005	Alcohol and/or drug services; group counseling by a clinician	15,950	$20	$239.3K
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…	4,610	$50	$225.9K
92508	The provider treats a group of two or more individuals with communication and hearing difficulties by directly interacting with them. He assesses the patients with impairment in their ability to make…	22,830	$10	$205.5K

Showing 1–10 of 22

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

Idaho Falls School District 91 — 2 of 22 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

22 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1019	Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, icf/mr or imd, part of the individualized plan of treatment (code may not be used to identify…	70	100	11,400	$80	$2M
H0004	Behavioral health counseling and therapy, per 15 minutes	18	160	4,020	$140	$1.6M
H2017	Psychosocial rehabilitation services, per 15 minutes	37	140	2,000	$110	$633.3K
H2014	Skills training and development, per 15 minutes	2	60	2,500	$60	$613.3K
H2019	Therapeutic behavioral services, per 15 minutes	59	60	2,960	$120	$609.8K
96152	N/A	3	70	2,270	$80	$608.8K
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.	22	280	1,480	$70	$389.4K
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…	34	210	3,020	$50	$389K
H0005	Alcohol and/or drug services; group counseling by a clinician	7	80	2,240	$50	$257.3K
99412	The provider offers advice on maintaining and improving health to a group of patients for roughly an hour.	2	10	3,060	$30	$172.5K

Showing 1–10 of 22

Nearby Providers

Other providers in the same ZIP code as Idaho Falls School District 91, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Bonneville School Dist #93	ID	Local Education Agency (LEA)	$0	$27.5M
Affiliates Inc.	ID	Developmentally Disabled Services Day Training Agency	$0	$9.9M
Transitions, Inc.	ID	Developmentally Disabled Services Day Training Agency	$0	$7.8M
Innovative Health Care Concepts, Inc	ID	Case Manager/Care Coordinator	$0	$5.7M
Stewards Of Recovery	ID	Community/Behavioral Health Agency	$0	$5.1M
Joshua D. Smith Foundation	ID	Developmentally Disabled Services Day Training Agency	$0	$4.1M
See Opportunities And Achieve Results	ID	Case Management Agency	$0	$3.8M
Porter Eyecare PLLC	ID	Optometrist	$0	$3.1M
Denture Clinic Inc	ID	Dental Laboratory	$0	$3M
Childrens Supportive Services Incorporated	ID	Social Worker	$0	$3M

Idaho Falls School District 91 — Billing Profile & Reimbursement Data

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Idaho Falls School District 91 — 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