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 1821460833)

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	October 29, 2015

Payer Source	Total Paid
Medicaid	$43.3M
Medicare	$0

Key Findings

This provider is effectively single-payer: there is no Medicare billing on file and all recorded federal billing activity is Medicaid-based, with total Medicaid revenue of $43.3M. The absence of Medicare claims means national Medicare peer comparisons are not applicable and analysis should focus on state Medicaid program participation and reimbursement patterns.

Revenue is extremely concentrated in a narrow set of Medicaid codes: the top three codes (H2016, S5136, H2015) together account for 97.8% of the provider's total Medicaid revenue. Specifically, H2016 generates $32.8M (75.7%), S5136 generates $7.4M (17.2%), and H2015 generates $2.1M (4.9%), so these three codes effectively define the business’s revenue profile.

The code mix and descriptions indicate a community-based, day/support services operation: H2016 and H2015 (comprehensive community support services, per diem and per 15 minutes) and S5136 (companion care, adult) point to ongoing day training, ADL/IADL assistance, and community support as core services. Ancillary codes such as H2025 (ongoing employment support), T2018/T1005 (habilitation and respite) further suggest supported employment and respite are offered but represent much smaller revenue streams.

H2016 is the dominant single code by revenue and volume (92.2K claims, $356 avg paid/claim, $32.8M revenue) and ranks #25 of 176 providers in-state (86th percentile). Despite its large absolute contribution, its in-state statistical standing is characterized as typical, unremarkable volume for this code, indicating the provider is a meaningful but not outlier-level participant in the state market for comprehensive community support services.

S5136 and H2015 together round out the top revenue drivers but neither shows an outsized statewide dominance. S5136 (29.2K claims, $255 avg paid/claim, $7.4M revenue) ranks #23 of 82 in-state (73rd percentile) and is described as typical, unremarkable volume; H2015 (4.1K claims, $515 avg paid/claim, $2.1M revenue) ranks #48 of 95 (50th percentile) and is also described as typical, unremarkable volume. The higher average paid/claim for H2015 compared with S5136 and H2016 suggests differences in billing units or service intensity across these top codes.

Several secondary codes appear but contribute negligible revenue relative to the top three: H2025 ($913.2K, 2.1% of Medicaid revenue) and a set of habilitation/respite codes (T2018 $13.6K, T1005 $11.3K, S5150 $1.7K) together indicate a broader service catalog that is not a major revenue driver. These smaller lines may reflect supplemental offerings (supported employment, waiver habilitation, respite) that diversify services without materially changing the provider’s Medicaid revenue concentration.

The provider has an established enrollment history (NPI enumerated 2015-10-29 (~11 years ago)), indicating roughly a decade of Medicaid-era operations. Given the high concentration in a few community-support and companion-care codes and the long tenure, the organization appears to operate as a specialized, community-oriented developmental disability/day training agency with most financial exposure tied to a small set of state-reimbursed service lines.

Medicaid: Complete Services Breakdown

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

7 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
H2016	Comprehensive community support services, per diem	92,160	$360	$32.8M
S5136	Companion care, adult (e.g., iadl/adl); per diem	29,180	$260	$7.4M
H2015	Comprehensive community support services, per 15 minutes	4,130	$520	$2.1M
H2025	Ongoing support to maintain employment, per 15 minutes	3,430	$270	$913.2K
T2018	Habilitation, supported employment, waiver; per diem	150	$90	$13.6K
T1005	Respite care services, up to 15 minutes	350	$30	$11.3K
S5150	Unskilled respite care, not hospice; per 15 minutes	20	$100	$1.7K

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 — 0 of 7 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

7 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
S5136	Companion care, adult (e.g., iadl/adl); per diem	23	80	9,410	$490	$17.9M
H2016	Comprehensive community support services, per diem	25	180	10,790	$390	$15.2M
H2025	Ongoing support to maintain employment, per 15 minutes	28	70	2,970	$300	$1.9M
H2015	Comprehensive community support services, per 15 minutes	48	100	4,130	$160	$1.9M
S5150	Unskilled respite care, not hospice; per 15 minutes	40	40	2,200	$240	$1.6M
T1005	Respite care services, up to 15 minutes	17	20	1,490	$160	$930.8K
T2018	Habilitation, supported employment, waiver; per diem	21	30	440	$100	$140.6K

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	$34.9M

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