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

Why is the Medicaid comparison limited to North Carolina 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. North Carolina (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.

Autism Society Of North Carolina, Inc. (NPI 1881751865)

Field	Value
Entity Type	Organization
Organization	Autism Society Of North Carolina, Inc.
Address	5121 Kingdom Way Ste 100
City	Raleigh
State	NC
ZIP	27607
Taxonomy	Community/Behavioral Health Agency
NPI Enumerated	January 2, 2007

Payer Source	Total Paid
Medicaid	$95.7M
Medicare	$0

Key Findings

This provider is effectively a single‑payer Medicaid operator: there is no Medicare billing on file and lifetime Medicaid revenue is $95.7M, indicating its entire reported federal revenue footprint is concentrated in Medicaid. Analysts should treat Medicaid as the primary and sole federal payer exposure for this entity.

Revenue is highly concentrated in a small number of waiver and habilitation codes: the precomputed top 3 Medicaid codes account for 67.7% of the provider’s total Medicaid revenue, driven by T2013 ($37.9M, 39.6% of Medicaid revenue), T2021 ($15.7M, 16.4%), and T2012 ($11.2M, 11.7%). This concentration implies that key business performance and reimbursement risk hinge on changes to those specific waiver/habilitation programs.

The provider’s code mix—dominated by T2013 (habilitation, educational, waiver; per hour), T2021 (Day habilitation, waiver; per 15 minutes), and T2012 (habilitation, educational; waiver, per diem)—signals a core business built around waiver-funded habilitation and day‑program services. Complementary codes such as H0045 (respite care services, not in the home, per diem), H2025 (ongoing employment supports), and multiple ABA codes (97153, 97155, 97152) indicate the organization operates a multi‑service autism/behavioral health platform offering day programs, respite, employment supports, and applied behavior analysis.

Against in‑state peers the provider is a major volume player on its top revenue lines: T2013 ranks #8 of 185 providers in‑state (96th percentile) and T2021 ranks #7 of 199 (97th percentile), both described as notably above typical state volume; T2012 ranks #12 of 110 (90th percentile) and is characterized as typical. These rank/percentile positions show the organization is among the leading statewide providers for day and hourly habilitation services, while its per‑diem habilitation activity is high but more within the state’s broader provider distribution.

Several individual codes mark the provider as an extreme outlier in specific service niches: H0045 is #1 of 82 providers in‑state (100th percentile; extreme outlier) with $8.1M revenue and 105.6K claims, T2025 is #1 of 81 (100th percentile; extreme outlier) with $2.8M, and H2025 is #2 of 55 (98th percentile; extreme outlier) with $5.1M. These extreme outlier labels indicate the organization supplies respite and certain waiver/ongoing employment supports at volumes far above typical state peers, suggesting specialized capacity and market dominance in those sub‑services.

The provider maintains a meaningful applied behavior analysis (ABA) and technician‑delivered treatment footprint: 97153 produced $4.6M (4.8% of Medicaid revenue) across 25.9K claims, 97155 produced $1.5M (1.5%), and 97152 produced $752.7K (0.8%) while ranking #2 of 26 in‑state providers (96th percentile) for 97152. While ABA does not drive the majority of revenue, these volumes reflect an established behavioral treatment capability that complements the habilitation and waiver services.

This organization has long tenure in the Medicaid landscape, with an NPI enumerated 2007-01-02 (~19 years ago), and its cumulative $95.7M Medicaid revenue and high claim counts on multiple codes reflect sustained, large‑scale participation in state waiver programs. That longevity paired with the concentration in specific codes suggests entrenched operational capacity around waiver habilitation and respite offerings.

For payers and network managers, the combination of high revenue concentration (67.7% in the top three codes) and multiple extreme outlier code rankings signals two priorities: ensure adequate contract and oversight coverage for unusually large volumes of respite/waiver services, and evaluate network capacity and reimbursement alignment for dominant habilitation/day‑program lines. The provider’s statewide leadership on several codes makes it a critical partner for access to waiver habilitation, but also a node of concentrated financial exposure if policy or rate changes affect those specific codes.

Medicaid: Complete Services Breakdown

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

26 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
T2013	Habilitation, educational, waiver; per hour	310,410	$120	$37.9M
T2021	Day habilitation, waiver; per 15 minutes	123,930	$130	$15.7M
T2012	Habilitation, educational; waiver, per diem	74,080	$150	$11.2M
H0045	Respite care services, not in the home, per diem	105,580	$80	$8.1M
H2025	Ongoing support to maintain employment, per 15 minutes	49,990	$100	$5.1M
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…	25,940	$180	$4.6M
H2015	Comprehensive community support services, per 15 minutes	59,630	$60	$3.8M
T2025	Waiver services; not otherwise specified (nos)	16,860	$160	$2.8M
S5150	Unskilled respite care, not hospice; per 15 minutes	23,670	$70	$1.6M
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…	7,070	$210	$1.5M

Showing 1–10 of 26

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. North Carolina Distribution

Autism Society Of North Carolina, Inc. — 6 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — North Carolina

Full comparison — all codes billed, vs. North Carolina median

26 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
T2013	Habilitation, educational, waiver; per hour	8	190	29,090	$150	$9.1M
S5135	Companion care, adult (e.g., iadl/adl); per 15 minutes	7	10	130	$90	$6.9M
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…	17	90	5,820	$310	$6.4M
T2012	Habilitation, educational; waiver, per diem	12	110	21,340	$180	$6.1M
T2021	Day habilitation, waiver; per 15 minutes	7	200	25,740	$130	$4.6M
H2015	Comprehensive community support services, per 15 minutes	17	250	10,060	$130	$2.4M
99509	A home health provider, such as a registered nurse, or a non nursing practitioner, visits a patient to provide help with activities of daily living, or ADLs, and self care.	1,450	1,450	23,320	$50	$2.3M
T2016	Habilitation, residential, waiver; per diem	79	90	5,520	$190	$1.6M
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…	22	80	2,260	$190	$1.4M
H2025	Ongoing support to maintain employment, per 15 minutes	2	60	6,380	$120	$1.3M

Showing 1–10 of 26

Nearby Providers

Other providers in the same ZIP code as Autism Society Of North Carolina, Inc., ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Rex Hospital Inc.	NC	General Acute Care Hospital	$0	$25.3M
Bayada Home Health Care, Inc.	NC	Home Health Agency	$0	$24.8M
Nc Dept Of Health And Human Service	NC	Clinical Medical Laboratory	$0	$16.4M
Jeffers Mann & Artman Pediatric & Adolesent Medicine PA	NC	Pediatric Adolescent Medicine Physician	$0	$10.9M
Pediatric Therapy Associates	NC	Physical Therapist	$0	$10.2M
Blue Ridge Day Surgery Center, LP	NC	Ambulatory Surgical Clinic/Center	$1.6M	$2.2M
John Thordsen	NC	Retina Specialist (Ophthalmology) Physician	$3.5M	$0
Rebecca Manning	NC	Retina Specialist (Ophthalmology) Physician	$3.4M	$0
Sachin Mudvari	NC	Retina Specialist (Ophthalmology) Physician	$3.2M	$0
Daniel Bennett	NC	Retina Specialist (Ophthalmology) Physician	$3M	$0

Autism Society Of North Carolina, Inc. — Billing Profile & Reimbursement Data

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Autism Society Of North Carolina, Inc. — 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