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

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

State Of Indiana Auditor Of The State (NPI 1912166075)

Key Findings

Field	Value
Entity Type	Organization
Organization	State Of Indiana Auditor Of The State
Address	402 W Washington St Rm W453
City	Indianapolis
State	IN
ZIP	46204
Taxonomy	Early Intervention Provider Agency
NPI Enumerated	June 4, 2008

Payer Source	Total Paid
Medicaid	$109.7M
Medicare	$0

The entity is effectively a single‑payer Medicaid operation: lifetime Medicaid revenue is $109.7M and there is no Medicare billing on file, so the provider’s financial footprint and payment risk are concentrated entirely in Medicaid. This makes state policy, Medicaid rates, and utilization controls the primary levers that will affect its revenue.

Revenue concentration is very high: the precomputed top three Medicaid codes account for 81.0% of the provider’s total Medicaid revenue. Those top drivers are 97530 ($52.5M, 47.9% of Medicaid revenue), 92507 ($20.8M, 18.9%), and 97130 ($15.5M, 14.2%), indicating the bulk of income comes from a narrow set of therapy codes.

The code mix identifies a core early‑intervention therapy operation: 97530 (therapeutic activities), 92507 (speech‑language services), and 97130 (one‑on‑one cognitive/therapeutic interventions) dominate revenue, consistent with an Early Intervention Provider Agency taxonomy. The prevalence of per‑15‑minute codes and both evaluation and treatment CPTs suggests a high-volume model of short, frequent therapy sessions and individualized one‑on‑one care.

Competitive standing within Indiana is dominant for many services: 97530 ranks #1 of 404 providers in-state (100th percentile; extreme outlier), 92507 ranks #1 of 388 providers (100th percentile; extreme outlier), and 97130 ranks #1 of 2 providers (100th percentile). These rankings indicate the provider is a statewide leader and an extreme outlier in volume for several core therapy codes.

Operational scale is very large: reported claim volumes for top codes are substantial (e.g., 97530 at 1.4M claims, 92507 at 769.2K claims, 97130 at 971.6K claims), implying extensive throughput and capacity to deliver therapy visits at scale. High claim counts combined with per‑unit payments drive the large dollar totals reported for these codes.

The provider’s dominance is not limited to the top three codes—multiple additional CPT/HCPCS appear as state outliers or leaders (examples include 97110, 92523, 97112, 97535, 92526, T1027), many ranked #1 or in the top percentiles and labeled as extreme outlier or notably above typical state volume. This pattern shows a comprehensive service mix spanning therapeutic treatment, evaluations, sensory integration, swallowing services, and family training consistent with a full early‑intervention program.

The provider has a long tenure in the NPI file (enumerated 2008-06-04, ~18 years), suggesting established relationships with state Medicaid and an entrenched operational presence that likely underpins the high volumes reported. Longevity increases the plausibility of sustained contracts, referral networks, and operational scale in the state.

The concentration of revenue in a few per‑15‑minute therapy codes and exclusive dependence on Medicaid creates operational and reimbursement risk: changes to Medicaid rates, prior‑authorization processes, session‑length rules, or utilization review for codes like 97530, 92507, and 97130 would materially affect overall revenue. Payer analysts should monitor policy and rate trends for these specific codes because they drive the provider’s financial performance.

Medicaid: Complete Services Breakdown

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

37 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
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.	1,419,600	$40	$52.5M
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…	769,160	$30	$20.8M
97130	The provider works directly one–on–one with the patient to help him improve cognitive functions such as thinking, remembering, reasoning, and problem solving and the ability to plan, organize, and…	971,610	$20	$15.5M
97129	The provider works directly one–on–one with the patient to help him improve cognitive functions such as thinking, remembering, reasoning, and problem solving and the ability to plan, organize, and…	969,830	$10	$5.8M
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	104,460	$40	$3.9M
92523	A speech–language pathologist (SLP) evaluates the patient's speech sound production for issues such as incorrect pronunciation and patterns.	42,990	$70	$2.8M
97112	Neuromuscular reeducation is a therapeutic treatment (exercise) performed by a physician in an attempt to reduce impairments and restore function through the application of clinical skills and/or…	82,410	$20	$1.6M
97535	A healthcare provider is required to give proper instruction to a person especially in cases of recovery from acute disease.	62,490	$20	$1.4M
92526	The provider treats a swallowing disorder through medications, rehabilitation, or a feeding tube, to identify the cause of improper functioning.	36,970	$20	$887.3K
97161	The provider, typically a physical therapist, conducts a physical therapy evaluation that includes history to rule out any adverse factors that will affect care; observes whether the patient's…	23,880	$30	$740.2K

Showing 1–10 of 37

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. Indiana Distribution

State Of Indiana Auditor Of The State — 23 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Indiana

Full comparison — all codes billed, vs. Indiana median

37 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
97130	The provider works directly one–on–one with the patient to help him improve cognitive functions such as thinking, remembering, reasoning, and problem solving and the ability to plan, organize, and…	1	10	486,640	$20	$7.9M
97129	The provider works directly one–on–one with the patient to help him improve cognitive functions such as thinking, remembering, reasoning, and problem solving and the ability to plan, organize, and…	1	10	486,380	$10	$2.9M
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…	1	390	3,600	$50	$511.6K
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.	1	400	1,100	$40	$382.2K
90791	In this service, the provider performs a psychiatric evaluation of the patient with the aim of making a diagnosis.	266	520	240	$80	$165K
97110	Therapeutic exercise is a form of physical therapy that utilizes specially designed exercises and activities to help patients gain better mobility and fitness levels. Normally used on patients with…	2	490	1,080	$30	$162.7K
T1027	Family training and counseling for child development, per 15 minutes	1	10	2,170	$30	$155.8K
97533	In this procedure, the provider uses sensory integrative techniques in patients with established dysfunction of sensory processing, for example, children with autism, and brain injuries. This service…	1	10	60	$20	$77.7K
97112	Neuromuscular reeducation is a therapeutic treatment (exercise) performed by a physician in an attempt to reduce impairments and restore function through the application of clinical skills and/or…	3	210	640	$20	$74K
92523	A speech–language pathologist (SLP) evaluates the patient's speech sound production for issues such as incorrect pronunciation and patterns.	1	50	80	$70	$70.1K

Showing 1–10 of 37

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Indiana University Health, Inc	IN	Home Infusion Therapy Pharmacy	$0	$178.1M
Volunteers Of America Of Indiana, Inc	IN	Substance Abuse Rehabilitation Facility	$0	$34.7M
Heartland Residential Services, Inc.	IN	Developmentally Disabled Services Day Training Agency	$0	$21.1M
The Health And Hospital Corporation Of Marion County	IN	Methadone Clinic	$138.9K	$17.3M
Indianapolis Public School	IN	Local Education Agency (LEA)	$0	$7.5M
State Of Indiana, Auditor Of State	IN	Public Health or Welfare Agency	$76.1K	$6.2M
Geoffrey Kline	IN	Podiatrist	$157.4K	$0
Ami Rice	IN	Obstetrics & Gynecology Physician	$127.5K	$0
Richard Paulsen	IN	Diagnostic Radiology Physician	$80.6K	$0
Toni Lin	IN	Orthopaedic Hand Surgery Physician	$79.6K	$0

State Of Indiana Auditor Of The State — 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