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

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

Balance Autism (NPI 1437290129)

Field	Value
Entity Type	Organization
Organization	Balance Autism
Address	1625 Adventureland Dr Ste B
City	Altoona
State	IA
ZIP	50009
Taxonomy	Developmentally Disabled Services Day Training Agency
NPI Enumerated	February 8, 2007

Payer Source	Total Paid
Medicaid	$34.9M
Medicare	$0

Key Findings

This provider is effectively single‑payer: BALANCE AUTISM has no Medicare revenue on file and reports $34.9M in lifetime Medicaid revenue, indicating its business is concentrated in Medicaid-funded services rather than Medicare. The absence of Medicare billing suggests payer strategy, contracting, and operations are built primarily around state Medicaid programs and reimbursement rules.

Revenue is highly concentrated in a small set of Medicaid codes: the top three Medicaid codes (97153, G9012, 97154) account for 72.8% of this provider’s total Medicaid revenue. In raw terms those top codes are 97153 ($18M, 51.6% of Medicaid revenue), G9012 ($4.8M, 13.7%), and 97154 ($2.6M, 7.4%), showing the business is dependent on a narrow set of services for the bulk of billing.

The code mix indicates BALANCE AUTISM operates primarily as an ABA/behavioral services provider with heavy use of technician‑delivered adaptive behavior treatment and associated supervision and assessment codes. High volumes for 97153 (technician one‑to‑one adaptive behavior treatment), 97154 (technician group adaptive behavior treatment), 97155/97156 (clinician supervision and caregiver training), and 97151 (assessment/plan development) point to a service model centered on direct ABA therapy, technician staffing, caregiver training, and clinical oversight.

Operational scale is substantial for technician‑delivered services: 97153 shows 148.6K claims at a $121 avg paid/claim producing $18M in revenue, which implies a large technician workforce and significant visit-level throughput. This claim volume suggests the provider must maintain high scheduling, training, and supervision capacity to support repeated short‑duration service units.

State competitive standing is dominant for multiple ABA-related codes: BALANCE AUTISM ranks #1 of 14 providers in‑state for 97153 at the 100th percentile and is labeled an "extreme outlier" for that code, while it also ranks #1 of 9 for G9012 at the 100th percentile and is described as "notably above typical" state volume. Multiple other ABA and assessment codes (97156, 97155, 97151, 97152, S5110) also show #1 rankings or 100th percentile placement, indicating the provider is a major statewide player in core autism/behavioral services.

Despite dominance in ABA codes, the provider’s footprint in other community support services is more modest: H2016 (comprehensive community support, per diem) generates $2.2M and ranks #106 of 176 providers (40th percentile), and S5136 (companion care per diem) produces $852.7K and sits lower in the peer distribution (~23rd percentile). These mid‑to‑low percentile positions suggest BALANCE AUTISM’s strength is concentrated in ABA treatment rather than broader community support or companion services.

Beyond the top three, revenue is diversified across related service lines that support the ABA model and family engagement: H2019 (therapeutic behavioral services) brings $2.2M (6.2%), 97156 (caregiver/guardian training) contributes $1.4M (4.1%), and 97155 (clinician adaptive behavior treatment) adds $1.1M (3.2%). While smaller than the top codes, these supporting services reinforce a full‑spectrum ABA program that includes clinician oversight, caregiver training, and therapeutic behavior supports.

The provider has a long operating history: its NPI was enumerated 2007-02-08 (~19 years ago), indicating sustained presence in the market and experience operating under state Medicaid arrangements. That tenure, combined with the concentrated revenue profile and #1 statewide rankings on core codes, suggests an established specialist role in Iowa’s Medicaid autism/behavioral services ecosystem.

Medicaid: Complete Services Breakdown

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

18 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…	148,570	$120	$18M
G9012	Other specified case management service not elsewhere classified	48,900	$100	$4.8M
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…	26,440	$100	$2.6M
H2016	Comprehensive community support services, per diem	6,190	$360	$2.2M
H2019	Therapeutic behavioral services, per 15 minutes	24,740	$90	$2.2M
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…	25,460	$60	$1.4M
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…	7,870	$140	$1.1M
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…	6,580	$150	$986.5K
S5136	Companion care, adult (e.g., iadl/adl); per diem	2,350	$360	$852.7K
H2015	Comprehensive community support services, per 15 minutes	680	$350	$237.3K

Showing 1–10 of 18

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Iowa Distribution

Balance Autism — 9 of 18 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Iowa

Full comparison — all codes billed, vs. Iowa median

18 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5136	Companion care, adult (e.g., iadl/adl); per diem	63	80	9,410	$490	$17.9M
H2016	Comprehensive community support services, per diem	106	180	10,790	$390	$15.2M
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	4,450	$130	$2.1M
H2015	Comprehensive community support services, per 15 minutes	79	100	4,130	$160	$1.9M
H2019	Therapeutic behavioral services, per 15 minutes	20	90	5,380	$100	$1.5M
T1005	Respite care services, up to 15 minutes	18	20	1,490	$160	$930.8K
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	840	$100	$877.3K
G9012	Other specified case management service not elsewhere classified	1	10	1,490	$120	$827.1K
H2014	Skills training and development, per 15 minutes	2	10	1,210	$150	$385.9K
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	200	$150	$266.6K

Showing 1–10 of 18

Related Providers

Other providers that share a Tax Identification Number (TIN) with Balance Autism, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Balance Autism	IA	Developmentally Disabled Services Day Training Agency	$0	$43.3M

Nearby Providers

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

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
City Of Altoona	IA	Land Ambulance	$192.4K	$164K
Hy-vee Inc	IA	Community/Retail Pharmacy	$284.5K	$61.1K
Stanton Danielson	IA	Family Medicine Physician	$249.9K	$0
Deborah Haines	IA	Family Medicine Physician	$98.9K	$0
Ashley Taliaferro	IA	Family Medicine Physician	$47.3K	$0
Timothy Holcomb	IA	Foot & Ankle Surgery Podiatrist	$30.5K	$0
Mark Adams	IA	Physical Therapist	$26.1K	$0
Brooke Pflum	IA	Occupational Therapist	$20.7K	$0

Balance Autism — Billing Profile & Reimbursement Data

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Balance Autism — 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

Related Providers

Nearby Providers

Frequently Asked Questions

References