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

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

Matrix Behavior Solutions, LLC (NPI 1760977649)

Field	Value
Entity Type	Organization
Organization	Matrix Behavior Solutions, LLC
Address	175 E Brown St Ste 202
City	East Stroudsburg
State	PA
ZIP	18301
Taxonomy	Behavior Analyst
NPI Enumerated	June 24, 2018

Payer Source	Total Paid
Medicaid	$75.6M
Medicare	$0

Key Findings

This provider is effectively single‑payer: there is no Medicare billing on file and all reported federal revenue is Medicaid-only, with lifetime Medicaid revenue of $75.6M. The absence of Medicare claims indicates business scale and exposure are concentrated in the Medicaid program rather than dual Medicare/Medicaid operations.

Revenue is highly concentrated in a small set of services: the precomputed top three Medicaid codes account for 80.3% of this provider’s total Medicaid revenue. The largest single driver is 97153 (53.3% of Medicaid revenue, $40.3M), followed by 97155 (16.5%, $12.5M) and H2021 (10.4%, $7.9M).

The code mix and volumes point to a core operation built around intensive applied behavior analysis (ABA): 97153 (159.8K claims, $252 avg paid/claim) reflects large-scale technician-delivered ABA sessions, while 97155 (52.8K claims, $237 avg paid/claim) captures clinician-administered ABA with protocol modification and supervision. High volumes for these codes combined with significant revenue shares indicate the organization runs a sizable field workforce of technicians supported by supervisory clinicians.

Competitive standing within Pennsylvania is dominant for the highest-intensity ABA codes: 97153 ranks #2 of 145 providers in-state (99th percentile; extreme outlier) and 97155 ranks #3 of 151 providers (99th percentile; extreme outlier). The provider also ranks #3 of 122 for 97151 (98th percentile; notably above typical state volume), signaling market leadership not only in delivered therapy but also in initial assessments and care planning.

Operational throughput is substantial: claim counts of 159.8K for 97153, 52.8K for 97155, and 46.7K for H2021 illustrate sustained, high-frequency service delivery and imply sizable staffing, scheduling, and billing operations to support continuous face‑to‑face sessions billed per 15‑minute units. This scale is consistent with a high-volume, Medicaid-focused ABA service provider.

The provider’s portfolio includes care planning and non-physician mental health services beyond direct ABA delivery: H0032 shows 35.8K claims, $179 avg paid/claim, $6.4M revenue (8.5% of Medicaid revenue) and ranks #16 of 209 in-state (93rd percentile). Additional codes such as H2019 (15.7K claims, $124 avg paid/claim, $2M; 87th percentile) indicate integration of therapeutic behavioral services alongside ABA.

Per‑claim payment levels for top services are moderate and comparable across assessment, supervision, and technician-delivered therapy—97153 $252 avg paid/claim, 97151 $249 avg paid/claim, and 97155 $237 avg paid/claim—so revenue is driven primarily by very high claim volumes rather than outlier per-unit rates. The combination of these per-claim values with the provider’s large claim counts explains the concentrated Medicaid revenue position.

The NPI has been enumerated since 2018-06-24 (~8 years ago), indicating several years of operational history to build the current Medicaid footprint. Given that tenure plus the provider’s extreme outlier status on core ABA codes, the organization appears to be an established, mature Medicaid-focused ABA operator within the state.

Medicaid: Complete Services Breakdown

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

12 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…	159,820	$250	$40.3M
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…	52,780	$240	$12.5M
H2021	Community-based wrap-around services, per 15 minutes	46,740	$170	$7.9M
H0032	Mental health service plan development by non-physician	35,770	$180	$6.4M
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…	18,880	$250	$4.7M
H2019	Therapeutic behavioral services, per 15 minutes	15,750	$120	$2M
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…	7,480	$160	$1.2M
H0046	Mental health services, not otherwise specified	1,720	$120	$213.4K
97158	The provider administers adaptive behavior treatment to multiple patients in a social skills group. Report this code for each 15 minutes that the provider spends face–to–face with multiple patients…	1,470	$120	$182.8K
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…	660	$180	$120.2K

Showing 1–10 of 12

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Pennsylvania Distribution

Matrix Behavior Solutions, LLC — 3 of 12 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Pennsylvania

Full comparison — all codes billed, vs. Pennsylvania median

12 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…	2	150	8,280	$220	$4.1M
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…	7	20	1,780	$210	$2.6M
H2021	Community-based wrap-around services, per 15 minutes	19	220	3,810	$100	$1.5M
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…	3	150	2,770	$200	$1.4M
H0032	Mental health service plan development by non-physician	16	210	3,020	$130	$1.3M
H0046	Mental health services, not otherwise specified	74	170	1,200	$130	$909.6K
97152	A technician, supervised by a physician or other qualified healthcare professional, provides supporting assessment of a patient’s destructive behavior and behavioral problems by interacting directly…	13	20	490	$270	$808.8K
H2019	Therapeutic behavioral services, per 15 minutes	25	180	3,510	$80	$685K
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…	3	120	1,330	$180	$557.5K
97158	The provider administers adaptive behavior treatment to multiple patients in a social skills group. Report this code for each 15 minutes that the provider spends face–to–face with multiple patients…	3	10	280	$230	$456.1K

Showing 1–10 of 12

Nearby Providers

Other providers in the same ZIP code as Matrix Behavior Solutions, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Loving Care Agency, Inc.	PA	Home Health Agency	$0	$27.4M
Lehigh Valley Hospital Pocono	PA	General Acute Care Hospital	$0	$11.9M
Family Care Centers Inc.	PA	Internal Medicine Physician	$0	$11.1M
Family Care Centers Inc	PA	Family Medicine Physician	$0	$6.1M
Gerald Negvesky	PA	Ophthalmology Physician	$446.1K	$0
Laszlo Szollas	PA	Interventional Pain Medicine Physician	$417.3K	$0
Gordon Fried	PA	Interventional Cardiology Physician	$305.5K	$130
Roger Componovo	PA	Adult Reconstructive Orthopaedic Surgery Physician	$299.8K	$0
Javed Malik	PA	Diagnostic Radiology Physician	$205.4K	$65.7K
Alan Westheim	PA	Dermatology Physician	$250.1K	$0

Matrix Behavior Solutions, LLC — Billing Profile & Reimbursement Data

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Matrix Behavior Solutions, 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