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

Why is the Medicaid comparison limited to New Mexico 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. New Mexico (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.

Prismtherapeutic Services Inc. (NPI 1497114003)

Field	Value
Entity Type	Organization
Organization	Prismtherapeutic Services Inc.
Address	2200 Gun Club Rd Sw
City	Albuquerque
State	NM
ZIP	87105
Taxonomy	Behavior Analyst
NPI Enumerated	February 11, 2016

Payer Source	Total Paid
Medicaid	$5.2M
Medicare	$0

Medicaid: Complete Services Breakdown

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

10 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T1026	Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per hour	14,410	$160	$2.3M
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…	3,900	$280	$1.1M
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…	5,280	$190	$991.7K
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.	4,370	$110	$480.9K
0365T	Adaptive behavior tx addl	1,250	$190	$236.3K
0369T	Duodenal mucosal resurfacing, endoscopic	480	$200	$95.5K
0364T	Behavior treatment	1,260	$30	$31.4K
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…	370	$70	$25.5K
0368T	Behavior treatment modified additional	490	$50	$23.8K
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…	110	$60	$6K

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. New Mexico Distribution

Prismtherapeutic Services Inc. — 4 of 10 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — New Mexico

Full comparison — all codes billed, vs. New Mexico median

10 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T1026	Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per hour	1	20	840	$160	$425.3K
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…	2	10	830	$190	$386.4K
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…	116	130	2,280	$50	$363.9K
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.	59	220	1,570	$70	$340.6K
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	450	$210	$239.4K
0365T	Adaptive behavior tx addl	1	10	710	$180	$128.4K
0369T	Duodenal mucosal resurfacing, endoscopic	1	10	480	$200	$95.4K
0368T	Behavior treatment modified additional	1	10	490	$50	$23.6K
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	10	180	$80	$18.2K
0364T	Behavior treatment	1	10	720	$20	$17.7K

Nearby Providers

Other providers in the same ZIP code as Prismtherapeutic Services Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
First Choice Community Healthcare, Inc.	NM	Federally Qualified Health Center (FQHC)	$0	$74.1M
Recovery Services Of New Mexico, LLC	NM	Methadone Clinic	$292.1K	$33.8M
Life Mission Family Services	NM	Assisted Living Facility	$0	$29.1M
Cornucopia Inc.	NM	Developmentally Disabled Services Day Training Agency	$0	$13.1M
Cdb Rio Bravo LLC	NM	Dental Clinic/Center	$0	$5.7M
Omni Medical Group LLC	NM	Clinic/Center	$0	$5.3M
Family Smiles, LLC	NM	General Practice Dentistry	$0	$5.2M
Pb & J Family Services, Inc.	NM	Community/Behavioral Health Agency	$0	$4.4M
Mandy's Special Farm	NM	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	$0	$4.3M
Albuquerque Guidance Center	NM	Mental Health Counselor	$0	$2.9M

Prismtherapeutic Services Inc. — Billing Profile & Reimbursement Data

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Prismtherapeutic Services Inc. — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

Nearby Providers

Frequently Asked Questions

References