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.

Carolina Center For Autism Services, LLC (NPI 1912069303)

Field	Value
Entity Type	Organization
Organization	Carolina Center For Autism Services, LLC
Address	4000 Sancar Way Ste 410
City	Durham
State	NC
ZIP	27713
Taxonomy	Behavior Analyst
NPI Enumerated	December 14, 2006

Payer Source	Total Paid
Medicaid	$41M
Medicare	$0

Key Findings

This provider is effectively single-payer in scope for the available data: there is no Medicare billing on file and all reported revenue is Medicaid-based, with total Medicaid revenue of $41M. The absence of Medicare activity indicates the organization’s commercial footprint, for Medicare populations at least, is negligible or outside the claims dataset.

Revenue is highly concentrated in a very small set of procedure codes: the top three Medicaid codes (97153, 97155, 97151) account for 95.4% of this provider’s total Medicaid revenue. Those three codes are driven primarily by 97153 ($30.8M, 75.0% of Medicaid revenue), followed by 97155 ($7.4M, 18.2%) and 97151 ($899K, 2.2%).

The code mix signals a dedicated applied behavior analysis (ABA) service model: 97153 (technician-delivered adaptive behavior treatment) dominates revenue and volume, supported by provider-delivered treatment and assessment codes (97155 and 97151). Average payments per claim reinforce this operational mix — 97153 at $335 avg paid/claim, 97155 at $259, and 97151 at $172 — consistent with a high-volume technician workforce supervised by qualified professionals.

Operational scale is evident in raw utilization: the provider reported 91.8K claims for 97153 and 28.7K claims for 97155, indicating a large caseload and capacity to deliver frequent, time-based therapy sessions. Those claim volumes, combined with the $30.8M and $7.4M revenues on the two codes respectively, point to a high-throughput service delivery model rather than a small specialty clinic.

Competitive standing in-state is strong for the primary ABA codes: 97153 ranks #4 of 88 providers (97th percentile), 97155 ranks #5 of 84 (95th percentile), and 97151 ranks #3 of 41 (95th percentile). These rankings indicate the provider is a major, top-tier participant in North Carolina for ABA-related Medicaid billing and substantially above typical state volumes for these services.

Caregiver- and supervision-oriented services appear as meaningful secondary components of the model: 97156 shows 9.6K claims for $662.7K (1.6% of Medicaid revenue) and ranks #4 of 65 providers (95th percentile), which suggests a systematic inclusion of family/caregiver training in the care pathway. A suite of T-codes and lower-revenue modifiers (e.g., 0365T, 0364T, 0368T) are present but together represent a small share of overall revenue, indicating limited ancillary service diversification.

The extreme revenue concentration in technician-delivered and short-interval time-based codes (97153/97155) creates both scalability advantages and concentration risk: the organization can scale by adding technicians under supervision, but changes to reimbursement rates, supervision rules, or prior-authorization policies for these specific CPTs could materially affect revenue. Given that top-three codes make up 95.4% of Medicaid revenue, payer or policy shifts targeting ABA service codes would disproportionately impact this provider.

Longevity in the market is established: the provider’s NPI was enumerated on 2006-12-14 (~20 years ago), supporting the conclusion that this is a long-standing operation in the state. That tenure, paired with top-decile ranks on core ABA codes, suggests entrenched referral relationships and operational experience in delivering Medicaid-funded behavioral health services.

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…	91,810	$340	$30.8M
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…	28,730	$260	$7.4M
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…	5,230	$170	$899K
0365T	Adaptive behavior tx addl	4,780	$140	$665K
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…	9,610	$70	$662.7K
0369T	Duodenal mucosal resurfacing, endoscopic	1,450	$210	$299.5K
0364T	Behavior treatment	4,940	$30	$123.4K
0368T	Behavior treatment modified additional	1,490	$60	$91K
0370T	Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present)	250	$120	$29.7K
97157	The provider discusses multiple patients’ adaptive behavior treatment face–to–face with a group of guardians or caregivers, without the respective patients being present. Report this code for each 15…	170	$40	$7.3K

Showing 1–10 of 12

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

Carolina Center For Autism Services, LLC — 3 of 12 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

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…	4	90	5,820	$310	$6.4M
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	80	2,260	$190	$1.4M
0365T	Adaptive behavior tx addl	4	10	3,990	$140	$567.1K
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	40	580	$210	$309.6K
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…	4	70	1,020	$70	$152.1K
0369T	Duodenal mucosal resurfacing, endoscopic	3	10	550	$170	$142.8K
0364T	Behavior treatment	3	10	4,050	$30	$104.1K
0370T	Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present)	4	10	330	$110	$50.9K
0368T	Behavior treatment modified additional	3	10	630	$50	$46.9K
97157	The provider discusses multiple patients’ adaptive behavior treatment face–to–face with a group of guardians or caregivers, without the respective patients being present. Report this code for each 15…	3	10	170	$80	$24.1K

Showing 1–10 of 12

Nearby Providers

Other providers in the same ZIP code as Carolina Center For Autism Services, LLC, ranked by combined Medicare and Medicaid revenue.

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
B & D Integrated Health Services	NC	Federally Qualified Health Center (FQHC)	$0	$48.8M
Upward Change Health Services, LLC	NC	Community/Behavioral Health Agency	$0	$18.9M
Amy C. Davidian, Dds, PA	NC	Pediatric Dentistry	$0	$15.4M
Community Care Service LLC	NC	Community/Behavioral Health Agency	$0	$11.5M
Carolina Community Support Services, Inc.	NC	Community/Behavioral Health Agency	$0	$11.1M
Med-el Corporation	NC	Durable Medical Equipment & Medical Supplies	$3.2M	$6.4M
B & D Integrated Health Services	NC	Family Medicine Physician	$0	$8.9M
Kc Care Management,inc.	NC	Adult Care Home Facility	$0	$8.3M
Greg J. Perentis Dds. PLLC	NC	Dentist	$0	$8.1M
Nuangels Home Care	NC	In Home Supportive Care Agency	$0	$7.1M

Carolina Center For Autism Services, LLC — Billing Profile & Reimbursement Data

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Carolina Center For Autism Services, 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