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

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

Easter Seals Southern California, Inc (NPI 1619255841)

Easter Seals Southern California, Inc is a behavior analyst provider located in Irvine, California. This profile covers 0 Medicare and 16 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	Easter Seals Southern California, Inc
Address	1063 Mcgaw Ave Ste 100
City	Irvine
State	CA
ZIP	92614
Taxonomy	Behavior Analyst
NPI Enumerated	July 21, 2011

Payer Source	Total Paid
Medicaid	$49.4M
Medicare	$0

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

16 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…	222,110	$80	$17.5M
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…	82,460	$110	$9.2M
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	68,020	$100	$6.9M
90885	The provider reviews the medical records of the patient pertaining to psychiatric evaluation to help in establishing the diagnosis and treatment plan.	60,110	$90	$5.4M
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…	35,460	$120	$4.1M
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…	87,870	$50	$4.1M
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…	1,270	$1,390	$1.8M
99072	The provider uses items, supplies materials, or requires clinical staff time in excess of what is normally used or provided for an office visit or other nonfacility encounter. These additional items…	119,000	$1	$238K
97167	The occupational therapist (OT) performs an evaluation requiring clinical decision–making of high analytic complexity, which includes analysis of occupational profile, problem–focused assessment…	120	$260	$30.9K
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.	3,840	$10	$23K

Showing 1–10 of 16

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. California Distribution

Easter Seals Southern California, Inc — 6 of 16 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — California

Full comparison — all codes billed, vs. California median

16 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	2,960	$150	$2.6M
90885	The provider reviews the medical records of the patient pertaining to psychiatric evaluation to help in establishing the diagnosis and treatment plan.	4	30	380	$90	$2M
H0032	Mental health service plan development by non-physician	944	980	1,080	$160	$1.5M
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	3,370	$110	$909K
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	80	1,300	$150	$798.6K
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…	529	570	14,830	$10	$531K
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…	16	960	1,820	$50	$351.9K
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…	9	40	330	$220	$230.1K
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…	5	60	450	$100	$121.1K
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.	265	1,190	930	$30	$117K

Showing 1–10 of 16

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Sunrise Respiratory Care, Inc.	CA	Oxygen Equipment & Supplies (DME)	$0	$36.1M
Md Tox Laboratory	CA	Clinical Medical Laboratory	$806.2K	$20.1M
Bach Medical Group, Inc.	CA	Anatomic Pathology & Clinical Pathology Physician	$3.2M	$6.1M
Red Chip Of Nevada	CA	Specialty Pharmacy	$7M	$0
First Bio Lab, LLC	CA	Clinical Medical Laboratory	$1.5M	$1.6M
Orange County Surgical Center	CA	Ambulatory Surgical Clinic/Center	$1.5M	$436K
Christopher Ninh	CA	Orthopaedic Surgery Physician	$393.9K	$974.4K
John Hewett	CA	Vascular & Interventional Radiology Physician	$1.1M	$146.4K
Neil Goldstein	CA	Vascular & Interventional Radiology Physician	$177K	$69.6K
Jessica Buus	CA	Physical Therapist	$153.5K	$0

Easter Seals Southern California, Inc — Billing Profile & Reimbursement Data

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Easter Seals Southern California, 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

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