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 District of Columbia for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to District of Columbia 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. District of Columbia (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.

Dcps - Public Schools (NPI 1962609701)

Key Findings

Field	Value
Entity Type	Organization
Organization	Dcps - Public Schools
Address	825 N Capitol St Ne Fl 7
City	Washington
State	DC
ZIP	20002
Taxonomy	Local Education Agency (LEA)
NPI Enumerated	June 27, 2007

Payer Source	Total Paid
Medicaid	$46.2M
Medicare	$0

This entity is effectively a Medicaid-focused provider: there is no Medicare billing on file and lifetime Medicaid revenue is $46.2M, making Medicaid the sole material payer on-record for DCPS - PUBLIC SCHOOLS. The lack of Medicare activity indicates the organization operates predominantly within a state-funded/student-focused reimbursement environment rather than serving fee‑for‑service Medicare populations.

The provider has long tenure in national enrollment, with an NPI enumerated on 2007-06-27 (~19 years ago), indicating an established presence and multi-year operational history in delivering services eligible for Medicaid reimbursement. That longevity supports the scale of claims volumes and service lines observed across the dataset.

Revenue is highly concentrated in a small set of procedure codes: the precomputed top three Medicaid codes account for 60.0% of total Medicaid revenue. The leading revenue drivers are 92508 ($11.2M, 24.2%), 97530 ($9.1M, 19.8%), and 92507 ($7.4M, 16.1%), showing that a majority of Medicaid dollars relate to a narrow set of therapy and speech services.

The mix of top codes points to a school-based, multidisciplinary therapy operation: dominant codes include speech-language services (92508, 92507, 92523), therapeutic activities/functional training (97530), group therapy/supervision (97150), behavioral health counseling (H0004, 90853, 90834), and psychological testing (96130/96131). Together these codes are consistent with coordinated in-school services for communication, motor/functional needs, and behavioral health rather than acute medical care.

Competitive standing within the state is strong for core speech and therapy services. The provider ranks #1 in-state and is labeled an "extreme outlier" for 92508 and 92507 (100th percentile), while 97530 ranks #2 statewide at the 97th percentile and is described as "notably above typical state volume," indicating market dominance in school-based speech and therapy delivery.

Several codes show particularly high group or supervisory volume and state-leading positions: 97150 reports 58.4K claims and $5.4M revenue while ranking #1 of 15 providers in-state (100th percentile), and H0004 reports 49.3K claims and $4.2M revenue ranking #1 of 82 providers (100th percentile, extreme outlier). These figures underscore a large-scale programmatic delivery model that relies on group sessions and recurring counseling visits.

There is significant activity in high unit-value evaluation and re-evaluation services: 96131 generated $2.9M from 1.2K claims with a $2460 avg paid/claim and ranks #1 of 3 providers (100th percentile, typical, unremarkable volume), and 97168 shows $740.4K from 384 claims with a $1928 avg paid/claim. These items indicate substantial investment in standardized testing and periodic re-evaluations alongside the high-volume treatment codes.

From a risk and operational perspective, the provider’s revenue profile is sensitive to Medicaid policy and reimbursement changes because a small set of therapy/speech codes drives the majority of revenue. While the breadth of codes (speech, OT/PT, behavioral health, psychological testing) suggests an integrated school-based services model that can cross-subsidize activity, any shifts in coverage, unit rates, or prior authorization for those dominant codes could materially affect the $46.2M Medicaid revenue base.

Medicaid: Complete Services Breakdown

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

14 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
92508	The provider treats a group of two or more individuals with communication and hearing difficulties by directly interacting with them. He assesses the patients with impairment in their ability to make…	137,960	$80	$11.2M
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.	41,570	$220	$9.1M
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…	39,130	$190	$7.4M
97150	In this procedure, the provider supervises and directs therapeutic procedures like exercise therapy for a group of patients.	58,430	$90	$5.4M
H0004	Behavioral health counseling and therapy, per 15 minutes	49,330	$90	$4.2M
96131	The provider, physician or other qualified healthcare professional, administers standardized psychological tests to a patient, interprets the results, establishes a treatment plan, and prepares a…	1,190	$2,460	$2.9M
90853	Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of…	12,270	$120	$1.5M
90834	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	7,950	$150	$1.2M
92523	A speech–language pathologist (SLP) evaluates the patient's speech sound production for issues such as incorrect pronunciation and patterns.	720	$1,410	$1M
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	11,060	$80	$829.4K

Showing 1–10 of 14

Medicaid: Competitive Analysis & Benchmarks

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

Claims Volume vs. District of Columbia Distribution

Dcps - Public Schools — 9 of 14 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — District of Columbia

Full comparison — all codes billed, vs. District of Columbia median

14 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
96131	The provider, physician or other qualified healthcare professional, administers standardized psychological tests to a patient, interprets the results, establishes a treatment plan, and prepares a…	1	10	220	$1,960	$1M
92508	The provider treats a group of two or more individuals with communication and hearing difficulties by directly interacting with them. He assesses the patients with impairment in their ability to make…	1	20	510	$70	$552.6K
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.	2	40	1,100	$70	$527.5K
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	30	1,170	$130	$489K
97150	In this procedure, the provider supervises and directs therapeutic procedures like exercise therapy for a group of patients.	1	20	2,420	$40	$415.3K
90837	In this service, the provider performs psychotherapy, a series of technique for treating the psychiatric disorders of the patient. The treatment session typically lasts for a minimum of 53 minutes or…	69	120	1,050	$110	$409.5K
H0004	Behavioral health counseling and therapy, per 15 minutes	1	80	2,570	$60	$403K
92523	A speech–language pathologist (SLP) evaluates the patient's speech sound production for issues such as incorrect pronunciation and patterns.	2	10	350	$460	$275.1K
97168	The occupational therapist (OT) performs a re–evaluation focusing on changes in the patient's functional, environment, or medical status that results in a revised plan of care; re–evaluation includes…	2	10	380	$980	$256.3K
96130	The provider, physician or other qualified healthcare professional, administers standardized psychological tests to a patient, interprets the results, establishes a treatment plan, and prepares a…	1	10	230	$280	$144.8K

Showing 1–10 of 14

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
Government Of The District Of Columbia Office Of Tax And Revenue	DC	Land Ambulance	$5.2M	$213.4M
Rcm Of Washington, Inc	DC	Intellectual Disabilities Intermediate Care Facility	$0	$53.9M
Wellness Health Services, LLC	DC	Home Health Agency	$0	$44.1M
Mcclendon Center	DC	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$31.9M
Office Of The State Superintendent Of Education	DC	Bus	$0	$30.7M
Mt&g Enterprise, Inc	DC	Developmental Disabilities Clinic/Center	$0	$24.3M
D.c. Department Of Behavioral Health	DC	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$19.7M
Amazing Love Health Services	DC	Community/Behavioral Health Agency	$0	$18.5M
Pathways To Housing Dc	DC	Mental Health Clinic/Center (Including Community Mental Health Center)	$0	$15.1M
Absolute Healthcare Resources, LLC	DC	Case Management Agency	$0	$13.1M

Dcps - Public Schools — Billing Profile & Reimbursement Data

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Dcps - Public Schools — 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